The UH ACO spearheaded an organizational push to build, refine and implement the UH Fractal Management System, a principal component of an enterprisewide Believe, Belong, Build Together socialization effort. The UH Fractal Management System operates at the speed of trust, prioritizes staff engagement in lieu of top-down control and empowers staff with organizational autonomy. It is built on the tenet that caregivers closest to the work are best equipped to ensure organizational success. 

The incorporation of publicly stated Objectives and Key Results (OKR) in the UH Fractal Management System provides transparent and repeatable common language frameworks that extend quality improvement initiatives from the board to the bedside. Constant reinforcement of psychosocial behaviors actively promotes desirable performance by way of stimulating humble inquiry, establishing peer learning groups and leveraging ongoing feedback and accountability loops to that ensure information is shared across teams, up and down the traditional organizational hierarchy and, ultimately, systemwide.