This article investigates the challenges faced by a respected hospital system after acquiring three medical practices. Despite financial stability, these practices struggled to adapt to hospital ownership, resulting in decreased performance, morale, and patient satisfaction. The core issue identified was a cultural clash between the hospital’s structured business model and the more flexible, informal management style of the practices. The article underscores the importance of understanding cultural differences and setting clear expectations in hospital-practice partnerships. By addressing these issues early, organizations can avoid frustration and build a cooperative, goal-oriented environment. The goal is to develop a trusting relationship between the hospital and its acquired practices, resulting in improved performance and satisfaction for all stakeholders.