Shared governance organizations have been highly successful in empowering nurses for professional practice. They have been more uneven in their effectiveness for solving day-to-day operational problems, however. This article discusses limitations of the traditional approaches and describes a process to develop self-managing teams through patient care redesign. Milestones in the evolution of self-managing teams are illustrated through a description of experiences at Presbyterian Hospital of Dallas over the past five years. Practical suggestions for the transition to self-managing work teams are outlined.