I agree that startups need to be very careful with adding people -- and that most are not. For whatever it's worth, at Oxide we have long past the scale where everyone knows everything (currently ~75 employees); there is no doubt turbulence ahead as we grow with respect to employees, but I do think that some of our cultural idiosyncrasies (e.g. writing-intensive, recording every meeting)[0] have helped/will be helpful in this regard.
[0] https://oxide-and-friends.transistor.fm/episodes/cultural-id...