In 2006 Guy's and St Thomas' NHS Foundation Trust not only had a financial challenge but also a cultural one: only just over half of staff would recommend the Trust as a place to work or receive treatment. This prompted the leadership team to embark on a journey spanning almost a decade, developing a values-based culture. The Trust values framework spans four levels of the organisation and sets out the values and behaviours expected of everyone, through to the strategic leaders in the organisation. This focus on leadership and behaviours at all levels has been underpinned with an appreciative inquiry approach to embedding the values and culture change. In this article, chief executive, Sir Ron Kerr, and OD colleagues, Sarah Morgan and Carolyn Norgate, detail the journey that Guy's and St Thomas' has undertaken, its impressive results, and the next stage in the Trust's journey.