One contributing factor I experience is that keeping competent, opinionated, leadership who are a good fit is an expensive proposition, and the "hold fast" position will always be challenged by whatever board is scrutinizing the budget/plan/forecast. The only play where no top brass has to catch a parachute is to bring in a consultant to scrutinize the business, read the crystal ball, and pitch a plan to weather the coming storm. Medicare funds are dust in the wind, Covid-era opportunities are dead and over, and the big axe has swung so much it needs sharpening. None of these are easy decisions to make and the result of "we're still doing what we're doing" is success.

Not to be glib, but is there any industry where management consultants have been shown to make a statistically significant difference either way?

Can't access the paper, but I'm curious how they measured statistical significance. I wonder how much to interpret the result as "we didn't measure any effect" (which is a largely meaningless conclusion) versus "no effect exists." The latter wouldn't be a rigorous statement, but it seems to be the conclusion we are being led towards.

Good to know I'm qualified. I am confident I can make no measurable difference.

There is a very clear effect, the bureaucrats can distance themselves from any unpopular policies or decisions and blame the consultants.

There's no such thing as a nonprofit. It's really just a question of whether or not the money goes to the shareholders or the management.

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