Even the research hospital I worked at had a proper SELinux setup on the Red Hat installations, but by-quantity most servers were CentOS and it was way more of a free-for-all than it should have been, e.g. I was the fed-up admin when I was really not qualified! I screwed up a lot. Not that big of a deal: this was research-related computing and deidentified data. All the clinical computing was Windows Server. That is not a coincidence, it is really a market difference.
As someone who hates Windows 11... I do like the core Windows kernel, and would much rather do IT on Windows machines than Linux machines. Windows NT is very fussy and a bit bloated, but a huge part of that is an admirable commitment to backwards compatibility; a lot of XP applications run fine on Windows 11, except DPI wonkiness. And Windows' driers advantage isn't just commercial support; the kernel is fundamentally leaner and faster than Linux at real-time IO, and better about cleanly isolating driver processes across privilege levels. Very broadly, compared to Linux I find administering Windows easier to navigate and harder to screw up, especially with handling user permissions. Surely part of this is what I grew up with, but there's also a values difference: a lot of Linux users like how low-friction it can be since the OS doesn't get in your way. I kind of like that Windows makes you turn an excessive number of disarming keys... even when I am frustrated by it.
It does make me quite sad that the only real general-use OS options are the apex of a 20th-century operating system family, Apple's version of that, and a truly 21st-century monolith-microkernel hybrid whose specific design is a mystery to public science.