Since 2012, the Iowa Healthcare Collaborative (IHC) has led the Partnership for Patients (PfP) Hospital Engagement Network (HEN) campaign in Iowa. In the first three years, participating hospitals prevented more than 3,300 harms with an estimated cost savings of $50 million. IHC led Iowa hospitals from an education focused quality assurance model to an execution driven performance improvement model. Iowa’s success was evident by the level of participation, uptake of best practices, and progress made toward advancing the aims of the PfP. Through this campaign, IHC became a leader of rural hospital quality improvement efforts.