This case study presents an example of local public health agency that adopted and institutionalized continuous quality improvement. As you read through the case refer to the NACCHO Roadmaps to a Culture of Quality Improvement (NACCHO, 2013) and consider questions According to the NACCHO Roadmap, which elements of a CQI culture are present and which appear to be lacking? What could the organization do to address elements that appear to be lacking? What are three additional steps the organization could take to ensure sustainability of the CQI efforts?