Yes. I work in 2nd one in my life currently, around 30 people, 15 technical/15 non-technical, remote. Not a single manager. I think we can scale it to 50. At some size I guess it would become harder, but I'd like to think it the spirit of it can be kept (lean and very low managers head count, just for coordination, HR and severe conflict resoultions stuff; let the people do their job and take accountability, pay them well and don't make them play carrier ladder games and internal competition trying to get promoted and destroying the cooperative culture).
First you hire more selectively, slower, with higher "fit" requirements (talented, flexible, aligned with technical choices), and everyone are well motivated, so it just doesn't happen that often. You just accept that people vary, some will have better ideas, more productive, go through things, etc. and that's OK. People should not have to constantly stress about their day to day peformance that much. But when there is a problem, multiple people talk about it with the top leadership over time and then it's eventually handled the usual way.