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29Founding Fathers HealthCorporation: Idealism and theBottom LineRichard Dykstra,Lara Fournier,Manish Parekhji, and Qin YeBackgroundFounding Fathers Health Corporation (FFHC) is a not-for-profit healthcare organizationlocated in the southeastern region of the United States. It includes a staff modelhealth maintenance organization (HMO), a very successful preferred provider organization(PPO), and thirteen hospitals in three states. Colonist’s First Medical Center(CFMC) is a 460-bed hospital with 1,600 medical staff members and is one of twoFFHC hospitals in a large metropolitan area in Virginia. Eighty of the physicians associatedwith CFMC are part of the staff model HMO, while another 120 are membersof practices owned by FFHC.Although it is a very large organization, the culture is consensus-driven and characterizedas “polite.” While this makes for a very pleasant work environment, it sometimesstands in the way of frank and open discussion. It is difficult to express stronglyemotional or differing ideas or positions because of the backlash that could result fromclashing with the polite culture. When a problem arises, there is much frustration inattempting to gain the system’s attention. Although consensus is the goal of decisionmaking, the sheer size and scope of the organization means decisions are often madeat anonymous and invisible organizational levels. Many find it difficult to find theperson or office responsible for correcting a problem when a grievance arises.A tradition of promoting from within has perpetuated the culture of the “civiltongue”—placing limits on career growth for more outspoken individuals. Recently,however, FFHC has been filling more management positions with candidates fromoutside the organization.These newcomers are more willing to speak out and challengethe established culture. It remains to be seen whether the organizational culture willtolerate them and the change that they might represent.CFMC has been widely regarded throughout FFHC as an early adopter of electronicmedical record (EMR) systems. Although it has had some notable failures in the past,it is moving to overcome its history through the establishment and support of a professionalinformatics department.The chief information officer (CIO), Ben Arnold, haswitnessed two failed implementations in the past 5 years.Betsy Ross, R.N., M.S. with a master’s degree in informatics, has had a long historyof patient advocacy. She was hired nearly 4 years ago as chief implementation officerat CFMC, shortly after CFMC suffered an embarrassing failure in a poorly plannedimplementation of an electronic admitting system at the hospital.Since then, Ross has worked closely with a charismatic physician, Dr. John Adams,who was then the director of medical informatics at CFMC. Together they envisioned250