Comprehensive Stroke Centers (CSCs) provide leadership to the surrounding communities they serve. Until state certification is mandated through legislative action, CSCs may be the best actors to create and improve stroke systems of care. Our CSC is in a state with 83 out of 126 Critical Access Hospitals. We launched the Kansas Initiative for Stroke Survival (KISS) in 2012, offering training and resources on quality measures and protocols necessary to recognize and treat stroke. Hospitals were invited to do an assessment of what they needed to do to become “stroke ready” and sign an attestation that acute therapy could be administered with telephonic assistance from a tertiary center and a transfer plan in place. In the first two years, over sixty hospitals participated, but those enrolled in KISS as emergent stroke ready did not show sustained improvement in stroke care. Door to needle time increased 25% in the last year. In response, our CSC created an independent executive board, representing professionals from nursing, emergency medical services, management, and medicine, to lead a broader statewide approach to education and accountability. Our new goals are to develop a statewide capability map, distribute a quarterly newsletter highlighting efforts across the state, and develop a website with links to presentations, protocols, and statewide data. We have already redesigned the data survey to enhance reporting and analysis, community-level boot camps have been implemented, and a statewide peer review has begun. Our CSC leads the quarterly peer review along with education that covers topics impacting outcomes, such as time from door to thrombolytic therapy and endovascular case selection; the first conference had 27 participants across the state. Our experience demonstrates that CSCs can lead statewide improvements in stroke care and that hospitals around the state are receptive to that leadership. Collaboration between hospitals can improve stroke outcomes.