Working for a group that has more chiefs than Indians, but the chiefs have difficulty making decisions on process improvements. Each site works under their "own way of doing things". There's a lack of systematic approach to process improvement, their behind the eight ball in EM. They have high rates of LWOT/LWBS, patient to provider, door to dispo and have hospital medicine clinicians as regional medical officers that have never worked a day in EM. It's extremely dysfunctional and embarrassing to the fellow EM Physicians and APPs due to incompetent leaders.