The Healthcare Improvement Skills Center 2.0 (HISC2) is an Internet resource for healthcare professionals. It is based on early work funded by the Center for the Health Professions at the University of California, San Francisco, and the Division of Information Technology Services at Case Western Reserve University, in a project conceived and originally lead by Linda Headrick, MD, Past President of the Academy for Healthcare Improvement (AHI), and Co-Chair of the annual AHI / IHI Scientific Symposium. Initial development pooled the efforts of talented professionals at the Case Western Reserve University and University of Missouri, Columbia Schools of Medicine, and the growing network of healthcare improvement practitioners and educators nourished by the Institute for Healthcare Improvement, in Cambridge, Massachusetts. The purpose of this website is to support a wide variety of efforts on the part of healthcare professionals to make systematic improvements in the quality of the healthcare they provide to their patients.

Long after the publication ofÊCrossing the Quality Chasm, there are surprisingly few resources available to support the development of basic healthcare improvement skills that are truly appropriate for working healthcare professionals. There are few resources that are:

• Easily and always accessible
• More practical than theoretical
• Rich with examples and illustrative cases
• Written in straightforward language rather than improvement jargon
• Highly interactive and engaging
• Helpful in dealing with the everyday issues that keep improvement efforts from getting off the ground

Early Work. In 2001, Dr. Headrick, then at the Case Western Reserve School of Medicine and MetroHealth Medical Center, received funding from the Network Contemporary Education Initiative, a project of the Center for Health Professionals at UCSF, to develop a "core curriculum" for improvement. Her intention - to pool the talents of a diverse group of healthcare improvement experts in order to craft a set of practical, web-based learning activities that providers would find easy to understand and complete. The point of the undertaking was to introduce core principles and methods of improvement in a down to earth way.

Experienced improvement educators were chosen to convert already successful learning units into highly engaging, self-study web modules. The resulting modules were peer reviewed by an interdisciplinary editorial advisory board of practicing clinicians, technical experts and internationally known quality improvement experts.

Subsequent Development. Review of that initial set of modules suggested that additional development work was warranted to bring them up to contemporary eLearning production standards. With the help of the Case Western Reserve University Division of Information Technology Services, an rfp was prepared and the services of one of the nation's leading e-publishing firms, Medical Directions Inc. (MDI), headed by Dr. John (Skip) M. Harris, Jr., were secured. With MDI's guidance, the modules were completely revamped, and finally published in the fall of 2005.

Over the next several years, based on feedback gleaned from participant evaluations, Module 6 was extensively revised. With the help of a small grant from the Institute for Healthcare Improvement's New Health Partnerships project, Module 2 was revised so as to incorporate an example of patient involvement in the work of an improvement team. Along the way we also added home page accessed suggestions about "Ways to Use the Modules," "User Comments," and a comprehensive, site-wide "Content Index."

Reception. The HISC website and its six modules have been well received by the healthcare improvement and medical education communities. The modules have been used by the Veterans Administration as a resource in the training of improvement coaches. And they have been incorporated into the American Board of Internal Medicine's "Essentials of Quality Improvement (EQI)" Maintenance of Certification (MOC) Part 4 performance improvement module (PIM) for clinically inactive Diplomates.

Administrative Responsibility and Editorial Leadership. When the modules were first published on the Internet, in 2005, administrative responsibility for the project was housed at the Academy for Post Graduate Health Care Education (APGHCE), in Columbia, Missouri. On July 1, 2010, full administrative and editorial responsibility for the next chapter in this project's history passed to the Improvement Learning LLC, in Shaker Heights, Ohio, headed by Dr. Mark Cheren, HISC2's new Editor in Chief. Prior to that time, Dr. Cheren served as Executive Director for the HISC initiative.

HISC2, A New Beginning. With this rebirth of the Healthcare Improvement Skills Center, as HISC2, have come several changes. After five years of doing so, we are no longer able to offer access to these modules on a no cost basis. Unrestricted access to the modules now requires payment of a one time, $50 fee. This fee will include CME credit for all completed modules at no additional cost.

We are pleased to announce that both CME credit and MOC credit are now available for the first time to clinically active American Board of Pediatrics Diplomates and American Board of Internal Medicine Diplomates via their respective Maintenance of Certification programs and websites, as an MOC Part 2 "HISC2 Quality Improvement Self-Assessment and Development Process" options. The framework for this implementation of the HISC2 modules has been specifically designed to help medical board Diplomates better prepare to demonstrate their improvement skills (their competence in practice-based learning and improvement) in MOC Part 4, the "Performance in Practice" segment of all American Board of Medical Specialties affiliated maintenance of certification programs.

Though the modules can be taken independently, when two or more are completed, participants should gain enhanced perspective concerning the many challenges and significant opportunities encountered when pursuing improvement in a systematic way. The 2001 Institute of Medicine report described a large gap between evidence-based best practice and what we achieve on a daily basis for our patients. Clinicians who complete these self-study learning modules will be able to address this gap in their own practices. They will be able to:

• analyze current care,
• generate hypotheses about the link between action and results,
• develop ideas about how to improve,
• design a test of a change in practice, and
• plan to disseminate and sustain successful results.

A diverse collection of healthcare improvement learning resources, featuring six case-driven, highly interactive learning modules. The modules provide a sound introduction to quality improvement in healthcare. They should prove particularly useful to those new to this work. Others may find that particular modules or parts thereof address critical gaps in their improvement skill set or contribute usefully to the enhancement of existing knowledge and skills. There are many other tools, links and citations on the site, as well. Some point to key quality improvement and healthcare improvement "classics." Others refer to more recent items from the literature, special resources, or to other learning modules on this topic. All have been designed and/or selected with the needs of practicing healthcare professionals in mind.

For five years we were able to make these modules available without charge. Unfortunately, beginning September 1, 2010, in order to be able to continue to make this resource available, we have found it necessary to assess a fee of $50 for those wishing to gain unrestricted access to the HISC2 modules, at this site. Access to an MOC QI self-assessment and development implementation of these modules will cost slightly more. It is our intention to continually enhance and expand this collection of improvement resources, and to make this site a place well worth returning to, on a regular basis, in your search for tools, resources and tips to aid you in your improvement work.

Completion of each module will ordinarily take between 55 and 65 minutes.

Jennifer Greene	Vanderbilt University	MD, MPH
Don Moore	Vanderbilt University	PhD
Roger Zoorob	Vanderbilt University	MD
Mark Cheren	Improvement Learning, LLC	Ed. D.

Advisory Board: http://www.improvementskills.org/aboutus/advisory_board.cfm

• Medical Directions, Inc.
• The Institute for Healthcare Improvement
• The Case Western Reserve University School of Medicine
• The Case Western Reserve University Division of Information Technology Services
• The Academy for Post Graduate Health Care Education
• Center for the Health Professions, UCSF