The first change from a PPM4Agile engagement is usually in attitude, and it can start right away: once people see that the organization values improving, they start collaborating across the lines they used to defend. The tangible change is a framework everyone works from. The workflow from idea to customer is written down, the roles and meetings at each point are named, the tools are configured and connected so work does not drop between them, and the metrics feed decisions instead of status meetings. With the whole system visible, people can spot bottlenecks and idle time and fix them themselves, and leaders can trace work to the goals it serves. How fast that happens depends less on the framework than on whether the people doing the work are open to changing how they work. The case study here shows that shift in one healthcare division, and the PPM4Agile framework describes the system it became.