At a time when policy makers are increasingly interested in shared decision making, this book tells the story of how to deliver tools created to help patients make better informed decisions. The real-world cases in this book, describe how pioneers from the US and UK introduced tools designed to help patients become well informed about tough decisions. They describe efforts to get the tools integrated into healthcare systems, sometimes with success, but often in the face of seemingly insurmountable obstacles. To better understand the challenges, each case in this book is reviewed through the lens of three different perspectives: Relational Coordination Theory presented by Jody Hoffer Gittell; Normalization Process Theory presented by Glyn Elwyn; and Microsystems presented by Marjorie M Godfrey. In the last chapter, Glyn Elwyn writes a provocative analysis of the steps that might be needed to facilitate large-scale implementation. Elliott Fisher comments in his foreword that “the gap between promise and reality remains deep and wide.” This book helps explain how we rise to meet this challenge.