Over-focused on productivity over individualized patient care. Staff is penalized for lack of productivity when spending time in patient-care activities that are not "billable". Time off sick (for self, children, or company's COVID requirement of 5 days off) is penalized through a points system. This encourages staff to work when sick and to not test for COVID because they will be forced into 5 days off of their PTO. Wages generally lower for most advanced professions than other locations, There is a lot of fluff and wasted time and money working toward employee engagement when this would be better spent on salaries, breaks during the work day, dedicated holiday and sick time, and general respect for professionals clinical decision-making skills.