The 3rd Edition of the AACVPR Guidelines for Pulmonary Rehabilitation (PR) Programs provides suggested program modifications that can allow a PR program to meet the needs of their pre and post lung transplant patients. The INOVA Fairfax Hospital Pulmonary Rehabilitation program did not feel it was meeting all the needs of this special patient population. To validate our feelings, the PR program developed an ongoing Outcome assessment tool in the Service Domain, being used with the post lung transplant patients and their families to improve the program and outcomes. An evaluation tool specific for the patient and an evaluation tool specific for a family/significant other are given to the post-lung transplant patients/family members. The results of this Evaluation tool is a very specific pre-lung transplant program design that will address the unique and specific needs of this very special patient/family population. The three PR programs in redesign are: pre-lung transplant patient and family program, inpatient lung transplant patient and family program and the post-lung transplant patient and family program. The evaluation tool documented changes that would be helpful in all components of pulmonary rehabilitation from assessment, education, therapeutic exercise, psychosocial intervention and long term follow-up. From QI to Program Re-Design. It really does work.