Over the past few years, a couple of major studies have shown, and the Institute of Medicine has emphasized, that the quality of health care in America is not even close to the level that we should expect from the world's most expensive health care system. Problems with quality are pervasive throughout both outpatient and inpatient settings and may be responsible for thousands of deaths each year.

Small rural hospitals are no exception in the continual reach toward a better, safer system, but they are at times forgotten both in terms of their contribution to health care and funding needed in order to maintain access to care for the country’s 59 million rural residents. Small rural facilities are faced with many significant challenges, the most pressing today related to finance and workforce issues. Despite these challenges, North Dakota’s small rural hospitals are committed to providing quality care and have worked together to develop something innovative, not to mention smart. Seeing strength in numbers, they banded together to form a single network committed to sharing the effort to improve quality throughout the state.