Unclear roles and decision-making authority.

Fragmented leadership without unity or shared vision.

Micro-management and centralised control.

High staff turnover and inconsistent approaches.

Poor communication flow from leadership.

Lack of leadership ownership and accountability.

Disconnection between leaders and operational realities.

Blame-shifting instead of problem-solving.

Culture of fear undermining effective decisions.

No shared vision or stability in leadership.

Widespread lack of trust in leadership.

Leadership promises not followed through.

Adverse impact on staff morale and well-being.

Disconnect between leadership rhetoric and reality.

Fear-based culture suppressing initiative and collaboration.

Senior leaders seen as distant or invisible.

Feedback not listened to or acted upon.

Engagement varies wildly between sites.

High leadership turnover disrupts relationships.

Staff feel disempowered and disengaged.

Communication seen as chaotic, unclear, and untimely.

Over-reliance on mass emails (“blanket bombing”).

Important messages often lost or ignored.

Lack of joint communication initiatives.

Disconnection between corporate and operational messaging.

Communication is mostly top-down and one-way.

No consistent strategy for information sharing.

Poor mutual understanding of roles and responsibilities.

Misalignment between intentions and delivery.

Fragmentation between operational and leadership levels.

Meetings lack purpose, clarity, and outcomes.

Too many meetings, often duplicative and unfocused.

Poor planning, preparation, and follow-through.

Culture of blame dominates discussions.

Meetings perceived as performative, not productive.

Siloed teams and lack of cross-functional collaboration.

Blame and defensiveness are default modes.

Low morale due to overwork and poor recognition.

Toxic behaviours go unaddressed.

Staff feel unsupported and isolated.

Processes are inadequate, inconsistent, or outdated.

Staff do not follow processes; leadership doesn’t enforce them.

Culture of “doing it my way” over standardisation.

Crisis management replaces structured planning.

New IT systems (CMS, IMS) are poorly implemented and not user-friendly.

IT systems are cumbersome, slow, and confusing.

Lack of training and user guidance.

Systems not fit for operational needs.

Poor integration across platforms.

Systems contribute to inefficiencies and contract risk.

Assurance processes seen as tick-box exercises.

Lack of feedback or corrective actions.

Inconsistent auditing and follow-up.

Contractual compliance over meaningful quality.

Low confidence in accuracy of assurance outcomes.

KPIs viewed as manipulated or irrelevant.

Disconnect between targets and actual delivery.

Performance reporting lacks transparency.

No learning or improvement from metrics.

Staff don’t believe metrics reflect real work.

Staff unaware of or disconnected from mission statements.

Statements perceived as corporate lip service.

No shared objectives across organisations.

Disconnect between values and leadership behaviour.

Objectives don’t guide day-to-day decision-making.

“Cost first” mentality undermines quality and value.

Short-term fixes trump long-term sustainability.

No shared understanding of value between parties.

Frontline needs ignored in strategic decisions.

Value perceived through profit, not impact.

OrgA and OrgB have fundamentally conflicting goals.

Lack of aligned purpose or mutual commitment.

Cultural differences erode trust.

Centralised decisions override local needs.

Adversarial relationship dominates interactions.

Mutual distrust and blame are entrenched.

“Them and us” culture undermines collaboration.

Joint ownership of issues is rare.

Leadership doesn’t model unity.

Contractual policing overrides partnership.

Collaboration is inconsistent and person-dependent.

Power imbalance prevents fair engagement.

Personality clashes hinder teamwork.

Local relationships stronger than systemic ones.

No shared identity or ethos.

Senior leaders are remote and disconnected.

Engagement happens too late or superficially.

Overburdened leaders struggle to prioritise people.

Site-level leadership often more effective.

Need for consistent presence and clarity.

Change is top-down and reactive.

Perceived as financially motivated by OrgB.

Change fatigue widespread among staff.

Local teams not empowered to adapt.

Poor rollout of IT systems hinders progress.

Blame culture dominates problem-solving.

Problems are ignored or delayed.

Little cross-communication on issues.

Third parties brought in after delays.

Solutions pursued only after cost implications considered.