Efforts to improve quality in healthcare require concerted action on the part of clinical and non-clinical staff and everyone who works with them. In complex healthcare systems, it is important to frame aspirations and goals in a language that works for everyone. The words that work for everyone to describe what good patient experience is like are: “warm,” “welcoming,” “listening,” “kind” and “friendly.” The Change Foundation vision for 2020 is important. Experience in the UK suggests that more emphasis should be placed on relationships and culture as important levers in engagement with patients and quality improvement as well as important barriers to overcome. High-level organizational changes and technical solutions make the process of change sound easier than seems likely, given the height of some of the barriers. Major changes in healthcare, especially where they entail changes in culture, take a long time, not least because of the ordinary problems of management and human relationships. The paper anticipates a longer journey to reach the destination of a truly patient-centred system and full engagement with patients and suggests identifying some staging posts that can be celebrated along the way.