Executive leadership operates with little to no transparency and fails to execute meaningful change management. Concerns raised by hospital-level management are often ignored or dismissed. Favoritism drives decisions at the top, including the creation of leadership roles that unfairly benefit select individuals. The organization supports toxic behaviors and a bully culture, destroying psychological safety and accountability. Inter-peer competition is openly celebrated, and Regional Managers emphasize financial performance to protect their annual bonuses—shifting focus away from people and patient care. Conflicts of interest within leadership further promote favoritism and give certain employees unfair advantages, breeding resentment and mistrust across teams.