Leadership is out of touch with how to best get things done, and doesn't appreciate that highly educated and experienced people who don't have background in biopharma/device space are not necessarily qualified to hold the positions they do. This leads to a lot of bad decisions, unnecessary delays and resentment from doers who are more knowledgeable than the decision-makers in their functions and organizations. People who are good at managing up often get rewarded in the absence of any real accomplishments, which leads to promotion of incompetence that perpetuates the cycle.