The California Nursing Outcomes Coalition (CalNOC) Partners for Quality (PFQ) to Reduce Patient Falls Project aimed to reduce the incidence of patient falls and the severity of fall-related injury in 33 California acute care hospitals. The project used an innovative telephone-based coaching intervention to link project coaches with hospital “team leaders,” who confronted challenges of changing falls-related practice. CalNOC’s prior experience affirmed reports that education alone catalyzes interest and perhaps fosters awareness of new practices, but it does not ultimately change behavior. The coaching intervention—multifaceted and involving local leaders—included specific consensus-building, interactive sessions, and guided practice. Coaches initiated and sustained contact with hospitals for nearly 3 years. In this paper, we describe the operationalization and challenges of the coaching intervention, from pre-engagement through closure phases. We also discuss strategies for extracting themes from the coaching process, feedback from participating hospitals, and results from self-assessments of participating hospitals describing the impact of the intervention on fall-related policies and clinician practices.