Broken lines of command occur when a task or decision is routed to a person or committee that either does not act on it or does not propose appropriate interventions. An example would be an infection control program that compiled statistics on the patterns of infection but did not attempt to change the protocols for handling infectious diseases. Another example would be a medical staff committee that did not take action on complaints against staff members. Such a committee would "break" the control loop by not proceeding to the intervention step. In this case, the broken loop would have serious legal implications, because it would be simple to demonstrate that the failure to take action against the errant physician was due to negligence by the oversight committee.
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