Over the last decade our organization has had a phenomenonal rate of growth that has allowed to be highly succesful in the rapidly evolving healthcare economic landscape. Initial efforts were more localized and building alignment was a bit easier becuase of the increased visibility and opportunity for interaction. Now as we are growing more across the region the distances are greater and we are beginning to partner with or aquire organziations that had traditionally very different missions than our parent organziation. We have always valued patient care/service, innovation and education but as we partner with organizations that have never had education and innovation as major parts of their mission we face challenges at times with getting everyone to understand the importance of these missions and the need to change behaviors and practices to support this. On the flip side, as we face increasing cost challenges, we are faced with trying to change behaviors of those who do thngs for “academic interest” when the behaviors do not improve and cost more. The overall story I think is about the need to blend and change cultures and is something that typically takes time. However, I don’t know that we can just take the time to let things evolve–we have to try to find ways to speed the process.