The patient-centered medical home is an approach to comprehensive primary care relying on well-developed systems. Research has shown that for practices to meet patient-centered medical home requirements, care models may need to be redesigned. However, there is a dearth of information about what factors are important to achieve this goal. Self-report surveys from 293 staff across 42 practices in Minnesota showed variation in use of systems and dimensions of organizational culture. Organizational cultures that emphasize collegiality and quality but not autonomy were significantly related to the use of clinician reminders, clinical quality evaluation and improvement, and clinical information systems.