I was driven to write this because managers/administrators get blamed for high and inconsistent staff hours per case (SH/C), when the reason for this outcome might be completely out of their control. When managers are pushed to lower SH/C they might inadvertently lower their staffing assignments to a point below what is acceptable for safe clinical care. When that happens, you will have problems ranging from sub-par patient and physician experiences— resulting in poor online reviews and lost cases—to bad clinical outcomes.