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Some good points form many who care, otherwise they would not be in the jobs that they are. The trouble is so many are blaming everyone else. The challenge is "what am I doing about improving patient care?". My quality standard has always been "Is it good enough for my mum?" Having worked as a director in the NHS for 30+ years and with some of the present key decision makers I have seen various management styles. rarely have i seen bullying. Yes I have seen hard decision makers who set stretching goals and don't except poor performance. Isn't that what you want in any high performing, customer focussed organisation? As a management consultant and advisor nowadays I often see mangers, including clinicians, who need to seek permissions to do things. A healthy organisation encourages their future leaders to take risks, to seek new opportunities and to deliver the plan. Too many managers seek an excuse for poor performance blaming the system or bureaucracy or targets. "Leaders think and talk about the solutions. Followers think and talk about the problems." —Brian Tracy