Over the past three decades, a plethora of programs, guidelines, tools, and techniques have emerged to improve person-centered care: "Care that is respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions" (Institute of Medicine. Crossing the Quality Chasm). Yet, implementation remains largely an aspiration. Individual's goals and values are often unknown, which leads to uncertainty, over and under treatment, avoidable suffering, increased costs of care, and moral distress for healthcare providers. Fulfilling the promise of person-centered care mandates the creation of a culture that seamlessly integrates person-centered decision-making programs to assist individual in making current and future healthcare decisions and designs systems capable of knowing and honoring an individuals' goals and values. Creating this culture is no easy task The co-creator of the nationally recognized Respecting Choices program shares twenty years of implementation experience creating a national curriculum and consulting with over thirty organizations around the U.S. and in five countries to disseminate the principles of two person-centered decision-making programs, Advance Care Planning (ACP) and Shared Decision-Making in Serious Illness. The perspectives and lessons learned are not intended as a panacea to resolve the daunting challenge in creating cultural transformation, but to promote conversation and consensus on the work yet to be done. The Respecting Choices "Promises" framework is used to explore five elements in building a culture of person-centered decision-making: leadership, system redesign, education and competency, community engagement , and continuous quality improvement.