I had lunch with the CEO of a major academic medical center today. He mentioned a key aspect of the culture of his top management team. In the conference room they use for weekly meetings, they have a list of shared norms and ground rules up on the wall. He explained how these norms are very useful to help the team engage in productive dialogue and debate. Moreover, this leader expressed how important it was that the team members held him and each other accountable for adhering to these rules of engagement. If someone didn't behave in accordance with these norms, they could be gently, or perhaps not so gently, reminded about their unacceptable behavior. They could be told that they had violated a particular rule. This leader concluded by arguing that building the right culture means you have to be specific about the behaviors you expect. In addition, people have to hold each accountable for adhering to these behavioral norms. Peer-to-peer accountability is key.