Consumer involvement in decision-making roles at the board and other levels within health care organizations has become increasingly important. Organizations of all types are recognizing that it is not enough merely to solicit opinions and feedback from patients and consumers—they must be meaningfully incorporated into the leadership of organizational design and governance to yield patient-centered policies and procedures. While efforts to engage consumers in decision-making roles within health care organizations are not yet widespread, useful lessons can be learned from 16 multi-stakeholder coalitions that are part of the Aligning Forces for Quality (AF4Q) program. Given their organizational structure and goals, the AF4Q Alliances have amassed a body of knowledge about effective strategies for engaging consumers in organizational leadership. The geographically diverse experiences of these groups offer a range of insights that can be helpful to those who are committed to engaging consumers.