Effectively engaging patients and family members is a necessary prerequisite to providing effective patient- and family-centered care. This article describes lessons learned during the six years after a large regional health care system in the U.S. established a systemwide infrastructure of patient and family advisory councils (PFACs) to help improve the quality, safety, and experience of care it provides. Successful elements are described, and the authors conclude that an openness to continuous improvement and adaptation was particularly important.