Demand for hip and knee arthroplasty in the United States is rising rapidly. This is creating considerable strain on healthcare systems' institutional resources and finances. To reduce this strain, Spectrum Health in Grand Rapids, MI, developed a strategy to decrease length of stay for most primary hip and knee joint replacement patients. Four specific interventions were undertaken concurrently: (1) communication with providers, (2) modification of patient communications, (3) standardized risk assessment and prediction, and (4) physical therapy on POD (postoperative day) 0 (i.e., the day of surgery). Length of stay was reduced an average of 0.5 days per patient for primary hip and knee joint replacement surgeries, creating a positive financial outcome without negatively affecting quality and patient satisfaction. This demonstrated the ability of a large, high-volume joint replacement center to transform organizational culture and generate rapid, measureable change.