Appeal to "stakeholders" and involving them in decisions and the processes through which decisions are made are becoming touch stones of "best practice," both clinical and managerial, in health care. Few organizations have sought to integrate stakeholders, especially patients and their caregivers, more completely than the National Institute for Health and Clinical Excellence (NICE) in England and Wales. This article outlines the circumstances in which NICE was created (1999) and the means through which it has created truly effective involvement of its many stakeholder groups. Key messages are that client involvement in decisionmaking is possible and can work well, but it demands commitment from the entire organization, specific managerial arrangements and, depending on the circumstances, it can be costly. Trust is an important ingredient of success.