Contractual policing overrides partnership

Outcomes constantly threatened, revised or pushed back

KPIs viewed as manipulated or irrelevant

Staff don’t follow processes and no enforcement

Disconnect between leadership rhetoric and reality

Difficulty attracting and motivating staff

Poor integration across IT platforms

Toxic behaviours go unaddressed

Communication mostly top-down and one-way

Operational overload and overwhelming busyness

Fragmentation between operational and leadership levels

Change is top-down and reactive

Regularly blindsided by external disruption

Site-level leaders often more effective than central ones

Local teams not empowered to adapt

Leadership promises not followed through

Collaboration inconsistent and person-dependent

Frontline needs ignored in strategic decisions

“Them and us” culture undermines collaboration

Staff feel disempowered and disengaged

Lack of joint communication initiatives

Engagement of front-line personnel superficial or too late

Mutual distrust and blame entrenched

Lack of aligned purpose or mutual commitment

Short-term fixes trump long-term sustainability

Senior leaders remote and disconnected

Blame and defensiveness are default modes

Third parties brought in to attempt to resolve delays

Engagement varies wildly between sites

Micro-management and centralized control

“Cost first” mentality undermines quality and value

Meetings lack purpose, clarity, and outcomes

Solutions pursued only after cost implications considered

Poor rollout of IT systems hinders progress

No shared understanding of value between parties

Siloed teams and lack of cross-functional collaboration

Culture of “doing it my way” over standardization

No consistent strategy for information sharing

Cultural differences erode trust

Meetings perceived as performative, not productive

Systems not fit for operational needs

Performance reporting lacks transparency

Processes inadequate, inconsistent, or outdated

Fragmented leadership without unity or shared vision

Over-reliance on mass emails

Poor mutual understanding of roles and responsibilities

Too many redundant and unfocused meetings

Feedback not listened to or acted upon

High staff turnover and retention issues

Disconnect between leaders and operational realities

Adverse impact on staff morale and well-being

No shared vision or stability in leadership

Poor communication flow from leadership

Leadership doesn’t model unity

Local relationships stronger than systemic ones

Low morale due to overwork and poor recognition

Power imbalances prevent fair engagement

No learning or improvement from metrics

Joint ownership of issues rare

Culture of blame dominates discussions

Lack of leadership ownership and accountability

Not enough shared objectives across organizations

Systems contribute to inefficiencies and increase risk

Blame culture dominates problem-solving

Overburdened leaders struggle to prioritize people

High leadership turnover disrupts relationships

Widespread lack of trust in leadership

Unclear roles and decision-making authority

Assurance processes seen as tick-box exercises

Little cross-communication on issues

Poor planning, preparation, and follow-through

Stated high-level objectives don’t guide day-to-day decision-making

Disconnect between corporate and operational messaging

No shared identity or ethos

Problems are ignored or solutions take too long

Decisions perceived as financially motivated

New IT systems poorly implemented and not user-friendly

Fear-based culture suppresses initiative and collaboration

Statements perceived as corporate lip service

Lack of feedback or corrective actions

Personality clashes hinder teamwork

Contractual compliance works against relationship quality

Senior leaders seen as distant or invisible

Crisis management replaces structured planning

Staff feel unsupported and isolated

Communication seen as chaotic, unclear, and untimely

Need for consistent presence and clarity

Culture of fear undermines effective decisions

Centralized decisions override local needs

Lack of effective and relevant training and user guidance

Staff unaware of or disconnected from mission statements

Blame-shifting instead of problem-solving

Misalignment between expectations and outcomes

Adversarial relationship dominates interactions

Staff don’t believe metrics reflect real work

IT systems cumbersome, slow, and confusing

Change fatigue widespread among staff

Disconnect between targets and end results

Inconsistency in auditing and follow-up

Contracting parties have fundamentally conflicting goals

Value perceived through profit, not impact

Important messages often lost or ignored

Disconnect between values and leadership behavior