AltaMed has an inherent psychologically unsafe environment due to the nepotism of the company. The CEO is married to the CAO. The CEO's two sons are VPs, and the CAO has a daughter who is a manager and a son who is in video marketing. From when I first started in the company, people of all levels told me consistently, "Be careful what you say because you never know who is related to the CEO." The enterprise is riddled with the CEO's family members and friends, so it concentrates power to those individuals. It's common knowledge that some leaders did not even interview for their roles, such as the Medical Director of Infection Control, because they are connected to the CEO's family and their friends. Because of this, leaders have learned to gaslight and talk down to any employees who ask questions, share concerns, or call out poor management practices. For example, the VP of Facilities makes decisions on clinic designs without proper expert input, at it affects patient safety. But because she is a VP who is close to the CEO, no one calls out the issue and she deliberately ignores people when asked why she makes decisions or concerns are shared. Additionally, because leaders are often family members or friends, there is no opportunity for growth. Leaders will tell employees that many people are often promoted after 3-5 years, but they do not take initiative to professionally develop employees or succession plan. I had a poor experience where I asked my supervisor about a promotion and was gaslighted by her and the HR Business Director at the time about my skills and experience. Speaking of HR, AltaMed is on its third HR VP in 2 years because they cannot retain the role. And speaking of retention, nursing turnover is very high. In the PACE division, they lost 3 nursing supervisors in a period of 4 months. It is all connected and points to why AltaMed is not a space of safety and belonging unless you do what you are told and idolize CEO and his family.