Being unwilling to adopt a necessary amount of structure and process is just as much of a hindrance once you hit a certain size.
That may be a newer or less common problem, but it's a very real one.
Every change I proposed was questioned to death and generally dismissed, I was micro-managed within an inch of my life, and I found the two key Directors just could not let-go of any control of their 'baby' (the company), to a point where any tasks I tried to assign to team members were met with pushback because the Directors had already assigned them other things, told them to work on other projects or asked them to report back before accepting any work from me.
One time when I was asked to work on a proposal to take over the migration, management and support of the Intranet for a large local University, I completed the initial RFP document and reported back to the Directors with a plan for a meetup with the potential customer because some key points needed elaboration, and some of the SLA terms could not be met without additional team resource, but they told me they had already phoned the Uni and agreed to go ahead 'as is'.
I left after 9 months.