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In recent years, mandates to improve healthcare quality and safety have created new challenges for hospitals in the United States. Medical centers now place great emphasis on redesigning healthcare delivery and improving their systems and quality of care to ensure broad-based safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity. Critical care leaders are being challenged to address the rising patient demand for critical care services, the intensivist workforce shortage, education of new generations of critical care medicine physicians and advanced practice providers. Critical care leaders are being asked to standardize care and technologies in hospitals with many ICUs, optimize ICU integration in inpatient care and hospital throughput, and participate in quality assurance, cost control, research, and fundraising initiatives. In response, medical centers are developing new organizational models—critical care organizations (CCOs) of centers, institutes, and service lines—to provide nimble and flexible suprastructures across their entire organizations.