Evolving a Culture of Medical Excellence offers a carefully researched, unvarnished history of the Hawaii Permanente Medical Group in honor of its sixtieth anniversary. Author Dr. Albert J. Mariani describes how this medical group, now the largest in Hawaii with 650 doctors, a democracy with principled leadership evolved a successful and durable culture of medical excellence that could serve as a model for similar doctor groups. Real life examples from the author's extensive experience illustrate that the good and bad of human nature can often be successfully approached by aligning interests. It is a study of how decades ago the very dissimilar cultures of medicine and business were reconciled in the traditional Kaiser Permanente program to the benefit of patients and society. It could have been a model for healthcare everywhere. Deviations from the traditional model - especially those that compromised the partnership - resulted in failure.