When building a culture of quality in LHDs, a natural evolution of change tends to occur, impacting both the people and processes within the organization. The QI Roadmap provides LHDs with guidance on progressing through six phases or levels of QI maturity until a culture of quality has been reached and can be sustained. For each phase, the Roadmap presents common organizational characteristics and strategies and resources for transitioning to the next phase. The QI Roadmap also describes six foundational elements of a QI culture that LHDs should cultivate over time. Whether a novice or advanced in QI, any LHD can adapt the QI Roadmap as a guide to understanding the current state and identifying next steps for advancing to the next stage of QI integration.