Hi Sean,
There are a bunch of settings that can improve write performance.
Probably the most critical one is to make sure you're on the very latest version of HAPI FHIR. Transaction write performance is something we test and profile often, and there have been improvements small and large in every release in the last 2 years.
There are also quite a few settings that you can tune that will help - There's a
doc page here with some details. It's a Smile CDR doc so it's linking to Smile settings, but all of the settings described are DaoConfig or ModelConfig properties so there's nothing discussed there that isn't open source.
Specifically, disabling deletes and enabling mass ingestion mode are big ones. It's also always a good idea to review your search parameters - Every enabled search parameter is one more thing to index during writes, so disabling one you know you'll never use can have a lot of impact.
Cheers,
James