After years of growth, most medical groups are now investing in integration to capture benefits from scale. Organizations often start with initiatives that offer clear efficiencies in time and costs, like the EHR. However, these changes are often the most disruptive to physician workflow, losing buy-in and stalling integration progress. Executives must lead with culture from the start, rather than focusing on workflow and efficiency alone. By prioritizing culture, leaders build organizational capital and a unified medical group that can withstand integration pressures. Just as architects construct a clinic from blueprints, executives must look to their own strategic goals as a guide for integration and building a cohesive medical group.