Growing interest in reducing costs for patients requiring long-term mechanical ventilation has led to development of different care delivery models. This article describes the development and implementation a respiratory care process model focusing on best practices and improvement in care, including early mobility. To implement the care process model, the authors had to make significant changes in the respiratory ICU (RICU), which included changes in how the RICU staff worked together. ICU culture was transformed in a way that resulted in improved and consistent care, including early mobility, while stabilizing or even decreasing cost. Involvement of front-line staff in early mobility and other components of the care process model resulted in the development of a culture of safety and teamwork.