Changes/Growth - There's no well-worn path for how to provide care to this patient population and so when this is combined with the company's growth, changes in medicare, and changes in medical technology, it can feel like there are frequently changes happening in terms of company structure, processes, standards, etc. Up side is that the changes tend to move things in the direction of making it easier for the clinicians and other employees to do their jobs and enjoy their lives. Fragmented technologies - There are a lot of digital tools the company utilizes to keep things running and not much interoperability between them. This means multiple sources of information and points of communication to accomplish relatively simple tasks.