Treat faithful employees like they matter, especially when they've given many years of good service, and don't blindside them with a layoff. My boss let me work all day then hit me with a pink slip an hour before the end of the workday, so I had very little time to clean out my work area, and then had to leave without saying goodbye to a lot of people I had developed friendships with over the years.
None, particularly. Administrators and management aren't open to suggestions and operate in a very closed, top-down manner. To improve, the overall culture would have to change to be more open and to have more personal accountability.
Come into the new century and treat employees with respect and be sure they have the appropriate safety equipment available and that they all are taught to use it. Counsel providers that are rude to staff and develop a zero policy towards staff abuse by management and providers. Stop with the Duke way, embrace change and best practices. Management needs to stay educated too.