Long-term engagement requires continuous effort over time. Long-term engagement is action oriented and requires administrators/collaborators to be mindful of what increases the likelihood that physicians will take actions that support the long-term goals. The Hawthorne effect is the conclusion of an analysis of factory production studies done between 1924 and 1932 at the Western Electric factory in Hawthorne, Illinois. The experiments were overseen by Elton Mayo, a professor of industrial research at Harvard. The Hawthorne effect is part of the healthcare improvement lexicon, describing the short-term improvement that often occurs when clinicians are made aware of an improvement project. Long-term engagement cannot be successful at low stages of the Physician Engagement Model. Long-term engagement means collaboration, with each side contributing their knowledge and understanding of the problem and visions of success. The focus of collaborative communication needs to be on continually identifying barriers to and opportunities for achieving the shared indicators of success.