Lack of communication, poor coordination, under qualified leadership/poor vision of ground level issues resulting in ignoring problems or bad problem-solving, lack of engagement/automating communication to the point of disconnection, lack of investment in clients, lack of investment in community/lifestance is an institution unto itself, it's a McDonalds franchise model for volume that maps poorly onto the complexity of mental health and employees get blamed for the problems with both the strategy and the infuriating lack of investment in technology, acuity and complexity of care is not a consideration in productivity