I miss being performance managed. When I'm judged based on performance, I have control of my reputation, career opportunities and future. I am in a union position and most opportunities are based on your seniority. Whether or not your input is taken seriously is based on seniority. Whether or not you have an opportunity to grow is based on seniority.
Management gets away with dodging directly managing you by over-using the "lead" or "senior" positions. This prevents you from knowing what is said about you and how the manager feels about you personally or about your performance. If your "lead" likes/trusts/respects you, they will pass on a good report. If they don't, it's human nature that they aren't interested in your success (and may want to get even) and will not pass on a good report. You have little or no control of this. Gossip is substituted for performance management here.
As with many companies, many job functions are being automated or out-sourced compared to 5-10 years ago, so if you don't have a clear medical specialty with an employment track record in that specialty, you are at risk.
If you are older, you are safe if you are an MD or RN but if you are not in a designated specialty, age makes a difference in transfers and promotions.
IT employees who need to purchase supplies have to do so with their own money and then request reimbursement. People who work from home likewise pay for connectivity and any related needs and then request reimbursement. I have worked elsewhere when this was billed to a company credit card or directly to the company (e.g. internet connectivity) without relying on the pocketbook of the employee to finance company business.
I have worked at companies with an open-door policy. Kaiser is not like that. If you go around anyone in management to accomplish a goal, it will be remembered and you may pay for it in the long run.