In a 900 bed tertiary institution with over one million outpatient visits annually, you would assume that there is a well defined organizational culture. Unfortunately, that is not the case within my hospital system. The core goals, roles, processes, values, and communications practices are absent. To the institutions credit, it has survived and thrived in a very challenging environment. However, I truly believe that the current success could be magnified three fold if the employees and medical staff could identify with a clear organizational culture.