State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the quality improvement area, a total of 218 items were listed by 47 EHDI coordinators, and themes were identified in each category. A threats, opportunities, weaknesses, and strengths, or TOWS, analysis matrix yielded 12 recommendations that focused on similar themes. Out of these 12 recommendations, 3 strategies emerged: 1) upgrade data management systems that will generate automated reports based on the state benchmarks coordinators wish to measure; 2) quality monitoring should be integrated into the state system at all levels and not as a separate job; and 3) all quality measures should be publically posted to hold the EHDI system accountable. Addressed appropriately, these recommendations can strengthen quality improvement in state EHDI programs. (Contains 6 tables.)