This document discusses the organizational structure, dynamics, and culture of Brigham and Women's Hospital (BWH) and Brigham and Women's Physician Organization (BWPO). It assesses the culture of BWH and BWPO, with specific attention to the physicians. It also explains the implications of organizational culture for the Shapiro Cardiovascular Center, with regard to the new practice model. Additionally, it describes barriers to change for the Shapiro Cardiovascular Center and uses motivational theories to assess the situation involving the physicians. Finally, it recommends four potential action steps to improve motivation for the physicians, including engaging support from board governance in the process change.