Several participants stated that executives seemed unwilling to share power with employees in order to
enhance service functionality. A number of participants felt that executives dismissed the value that the
community health employees added to the integrated model, which caused strong feelings of powerlessness,
dissatisfaction and alienation. These participants felt that the executives lacked understanding of the primary
health care paradigm, which resulted in their perception of community health staff roles as not as important as
acute ones. Many participants stated that community health needed greater representation at the leadership
level to ensure that the primary health care approach was viewed as a valid professional paradigm within the
integrated service. This point concurs with Leutz's fourth rule of integration, viz. "You can't integrate a square
peg and a round hole.