This case study describes how quality design methodology was applied by three waves of teams to improve the quality and accessibility of obstetric care in the Comayagua and La Paz regions of Honduras. As part of the Latin American and Caribbean Regional Initiative to Reduce Maternal Mortality, the Quality Assurance Project is facilitating the design of quality obstetric care processes at hospitals and health centers in Honduras. Composed of health staff and community leaders from six Honduran municipalities, the teams applied the 10-step quality design methodology to improve a variety of hospital processes. These include reception and triage, transportation for obstetrical emergencies, referral and counter-referral, medical records, labor monitoring, normal delivery care, prenatal care, postpartum care, management of complications, and neonatal care. Overall, regional capacity to deliver quality obstetric care has been enhanced by the coordination and information sharing between quality design teams.