Top heavy leadership and management is highly political and hierarchical. Too many leaders with limited power to make actual meaningful changes in the day to day operations. Those with the least power in the system that do the most work are often identified as the problem when conflicting management messages arise. Management opens dialogue about opinions on changes for patient care, but does not actually take the feedback into account (token of a democratic, egalitarian system). Individuals are asked to take on leadership roles and quality improvement projects with limited support (no time is bought out despite reiteration of the importance of these activities). Management allots 8 hours per week for all clinical documentation, email and MyChart messaging, mandatory clinic meetings, leadership requests, and peer supervision. Supervisors do not receive productivity credit for supervisees, and supervisors earn only one hour of credit per week per supervisee towards their three-hour Harvard rule, which is volunteered service time to maintain Harvard faculty status (does not account for curbside supervision or revisions/signing of notes). Difficult to identify managers responsible for certain issues and reach out to leadership in effective ways (obscure hierarchical system that limits constructive feedback).
