This study sets out to contribute to the understanding of current practices in digitization projects at small and medium-sized cultural heritage institutions by interviewing digitization project managers at four of these institutions and analyzing their responses as case studies. The overarching theme of this study is the necessary transition from project to program at these institutions, and what these institutions are doing to make this transition. Additionally, this study looks at digital storage media and repository management at these institutions, which is an under-documented area of current practices. Through the use of a literature review and four case studies, several recommendations are made for improving the state of the art of digital preservation at these institutions and preparing them for the transition of digitization projects to digital programs.