Substantial variability exists in the use of critical care for patients with acute respiratory failure (ARF), suggesting a knowledge gap about when and how to best use the ICU. User-centered design (UCD) methodology- a systematic approach that prioritizes the needs of service end-users and involves multidisciplinary teams to develop and rapidly iterate novel, feasible solutions- is a potential approach to develop innovative care delivery processes that improve the quality and efficiency of care for patients with ARF.