Health reform efforts have been a catalyst for some health care organizations to work with patients and families to redesign and improve the care experience. Numerous compelling stories link these partnerships to improved clinical outcomes and experience of care scores. Yet less than one-third of primary care practices have engaged patients and families as improvement partners. The experiences of the ten AF4Q Alliances that undertook efforts to forge partnerships with patients and families were varied and provide insight into what is needed to effect lasting change.