Fifty years ago, the belief that physicians and managers could effectively share responsibility and accountability for overall performance of health systems brought the wrath of the American medical establishment down on the first generation of Permanente physicians, who were excluded from their local medical societies. Then, the hard work of making such a partnership succeed nearly destroyed Kaiser Permanente in its first decade.

The outcome became the key to the success of Kaiser Permanente today, as well as one of the organisation's most distinctive characteristics: an organisational culture that transcends the traditional conflicts between …