| Cultural Attributes | Key Elements |
| Patient-Centered | - Conceptualize patient and family as the “customer”
- Focus on exceeding the customers’ expectations
- Involve the patient in informed medical decision-making
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| Quality-orientation | - Burden of proof is on those who think cutting corners on quality makes business sense
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| Lean Thinking | - Think of work as a process and the ACO as a system
- Engage front-line staff in identifying and eliminating wasteful process steps
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| Evidence-based | - Use objective data rather than subjective intuition
- Consider uncertainty explicitly and quantitatively
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| Medical Professionalism | - Adhere to the principles of the Hippocratic Oath
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| Integrity | - Commit to truthfulness and transparency regarding clinical performance, medical errors and treatment effectiveness to patients, payers, employers, regulators, accreditors, professional associations, and public health officials
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| Balance between collaborativeness and competitiveness | - Be sufficiently collaborative to create processes that cut across traditional organizational and professional boundaries
- Be sufficiently competitive to leverage benefits of a free market in terms of justifying capital investment and motivating difficult change
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