Medication reconciliation was initially established as a National Patient Safety Goal (NPSG) in 2005. However, difficulty establishing and implementing effective medication reconciliation approaches led to The Joint Commission suspending evaluation of this NPSG in 2009 and eventually eliminating it as a separate NPSG in 2011. This report from a large health care system provides a detailed template for integrating medication reconciliation into clinician workflow in the outpatient setting. Through a combination of leadership engagement, rapid cycle quality improvement projects, and financial incentives, the organization achieved consistent and sustained improvement in documentation of medication reconciliation for pediatric patients over a 5-year period. As medication reconciliation has been less studied in the ambulatory care setting, this study provides a useful window into the barriers inherent in changing outpatient clinician workflow and the steps this organization took to minimize unintended consequences of the intervention.