Dr. Jessica Israel, senior vice president of geriatrics and palliative care at RWJ Barnabus Health in New Jersey, shares how she built a palliative care service line across the largest academic health care system in the state. She discusses how her communication skills expertise (from palliative care training) set the stage to achieve systemwide collaboration, and how she purposefully sought to unify, improve, and streamline the teams and processes, while allowing each site to retain its own personality and structure.