XYZ Clinic is a community health center and many of the employees are not happy with the leadership. With changes occurring such as focusing on numbers there has been a lack of delivering high quality medical care because they are only worrying about attending to MCD patients. Many of the employees have lost morale because they feel underappreciated or not appreciated at all. Below are notes to include in the letter to be sent to board members. The purpose of the letter is to share the general concerns that have recently arise. Hoping with this letter that these concerns are looked into and proper measures are taken to resolve or address. In no means this letter is to complain but to express the growing issues. We have followed chain of command with no resolution and have been pushed to this last resort. Does not generated enthusiasm among employees No leader characteristics like creating trust, being approachable, trust others who have expertise in their jobs (employees who are working for XYZ Clinic for years in the medical side). There is No interest in learning the medical aspect of XYZ Clinic to be more informed and make informed decisions, understanding the basic about the medical side will allow not just made more informed decisions but increase satisfaction services in the medical staff and patients. For example, the new "implementation" at no show policy, putting the patient No Show even when the patient call the same day. It`s almost we are forgetting what kind of patients we work with at XYZ, most of our patients are struggling financially, does not have reliable transportation, live in a difficult situation struggling financially, depend of the weather to walk to the clinic with their children, some are even homeless and now we are going to dismissed patients because they struggling in life and make a cancelation the same day of their appointment? Some patient are so preoccupied with being unemployed, being single mother, deportation of the close family members, no place to live, legal status in this country and now we decided to dismiss them. Another example of how medical works understanding how much time providers spend ( we would say an average of ten hrs of their own time) doing notes, Rx,etc Medical providers take the work at home, providers are feeling resentful and disrespect . the CEO is not approachable if there is a concern employees need to talk to Medical Director but we can`t talk to him directly the CEO never invest time to talk to XYZ employees, does not to take the time to legitimize listen to employees creating a demoralizing sense among the staff. Create a demoralizing environment and distrust, He does not take the time to listen and understand concerns. During all staff meetings if a question or concern comes up he said "we would check this" and immediate change subject. If there are any constructive feedback seem like he act defensive and dismissed the feedback. We recently lost some medical and administrative employees for what seem like dissatisfaction in the management style of the CEO. We believe the XYZ board needs to be informed and read all the exit interviews to find solutions before we lost more valued employees. Most of XYZ employees have never had their annual review unfortunate we ALL need to be reviewed, allowing some to be better employee and grow. Our main concern is the lack of trust within the leadership of this organization. This includes leadership at the sites, administration executives, even up to your daily peer co worker. This issue arouse when the new leadership took place within XYZ Clinic. What we mean by trust includes being able to express our ideas, our concerns, suggestions, having a voice as an active employee of XYZ. Even employee that have been in the XYZ system for years with many experience are not taken into consideration or heard. This is a great asset to use due to the experience they have working directly with the patients. A simple anonymous employee survey could point out how unsatisfied they are. We feel that this could improve by asking input from EVERY department (front desk, medical, pharmacy, dental, admin, billing, etc.) before making changes and decisions affecting each dept. Even gathering input from patients on how certain changes may effect them or benefit them. This will help every department be on the same page. Another idea is to place staff members/employees that are culturally sensitive, that still believe in the XYZ mission. Related to the above is the disconnection throughout XYZ Clinnic. Disconnection- teamwork, trust for leadership, working towards the same goal/value, feeling valued as an employee, employees that work directly with patients not having voice or input in decision making. Directly from the CEO there is a lack of communication, lack of understanding the clinical aspect. There is a clinical knowledge unbalance in the executive team (limited members understand or have experience working directly with the patient) and even then they make changes without consulting other valuable knowledge or ideas from all departments. Please do not take our word for it, investigate. If we took this desperate measure to contact the board is because the rapidly growing issue. We are concern this pattern going to end devastating XYZ as a organization. I understand the budget it`s very important, the majority of employees feel under appreciate. I am not talking about money and salary. I am talking to cheer up people, emails to recognize what we do well and not just receiving emails about what changes going to be or just bad news, etc. it will be nice to sometimes revive an email let us know they understand how hard we work, telling even we don`t receive raise of salaries they know we work hard. But always always it`s negative reinforcement. Talking with other employees I got a feedback that I found interesting. "XYZ Clinic is hiring all the bilingual, bicultural, to do the work but look who are the bosses here are all white people" this person said "I feel we the brown people are here for the mission and all the white people are making good money and making decisions" "I could get a easier job in a bank or something like that but I am here because I will help my community but I do not feel appreciate" This letter is to be intended from a current employee speaking up and representing all employees at XYZ Clinic. The mission of XYZ clinic is to serve the medically underserved and that is not happening any more based on the notes above.