Shared decision-making has become a hot topic in healthcare. This article describes a step-by-step, ‘how-to’ approach to implementation of an interprofessional shared governance and relationship-based care model at a 300-bed tertiary academic medical centre in a large metropolitan area in the US and outlines the lessons learned. The project, undertaken in ‘waves’, encompassed inpatient and ambulatory services and has been sustained for over eight years.