A senior NHS Orkney medic has resigned claiming failings by the board make him "fear for the safety of patients".
Clinical Quality Advisor Dr Roelf Dijkuizen accused the board of "dysfunction" and said clinicians were not trusted to make decisions.
In a resignation letter he says he has never worked anywhere where there is so much confusion about roles and responsibilities.
NHS Orkney confirmed Dr Dijkuizen had resigned.
The Scottish government said the health board must "urgently look at the matters raised in this letter".
In the letter, which has been widely circulated, Dr Dijkuizen says he was unable to persuade the organisation of its shortcomings as a member of staff and decided to resign so he could make his concerns known publicly "before it is too late".
He praises facilities at the new Balfour Hospital in Kirkwall and the front life staff working there and in services across the community in Orkney.
But he says "dysfunction" has been building up within the organisation over the last two years, and he claims "a culture of negative, deficit-based thinking and a pre-occupation with finance" has crept into the executive director team and the board as a whole.
He says executive directors have started to micro-manage staff, "not trusting anyone to get on with anything". He wrote that this has created "potentially serious conflicts of interest" between the safety of patients and making financial savings.
And he claims the issue has united senior clinical and non-clinical staff "in their frustration about the lack of authority to make any decisions".
He says the issue was "cruelly exposed by the Covid-19 pandemic" and claims it led to difficulties in supplying protective equipment to staff, and in organising testing for the virus.
Dr Dijkuizen said clinical and non-clinical staff were part of a team which came up with "collaborative solutions for the unprecedented challenges" posed by the epidemic.
But their decisions had to be approved by executive directors who "seemed unable to agree on anything".
In a statement, a spokesperson for the Scottish government told BBC Radio Orkney that: "All health boards should be delivering safe, effective and person-centred care for our communities.
"The Scottish government remains in touch with NHS Orkney, as with all health boards, to support them as health and care services begin to remobilise."
No-one from NHS Orkney has been available to react to Dr Dijkuizen's claims.