In a busy academic medical group practice or in any business, intentional consideration of the organization’s culture is crucial. This paper intends to explore the role optimizing organizational culture plays in transforming an academic medical group practice and the effects on its subsequent performance. This paper aims to provide a road map of the steps taken and lessons learned while changing a medical group practice’s culture from good to great. Changing an organization’s culture can be a difficult and lengthy journey. However, the efforts can be transformative. This focus paper also details leadership’s role in changing the organization’s culture. Process improvement tools utilized, such as lean six sigma, are discussed. Improving your practice’s employee and physician engagement is outlined. Common pitfalls to avoid while embarking on such an effort are disclosed as well as alternatives to consider. As the healthcare environment continues to evolve, organizations must be ready to move in a more nimble way. Productivity, efficiency and the ability of the organization to adapt to rapid cycles of change will become increasingly important. However, these must be balanced with a mindset of patient centeredness. Keeping the patient central regarding all decisions, along with improving operational systems and the organization’s culture, will better prepare medical practices for the future.