About HISC version 3.0

The Healthcare Improvement Skills Center (HISC, version 3.0) is an internet resource for professionals in healthcare. It is here to help you make systematic improvement in the quality of care you provide to your patients.

The Need

Long after the publication of the National Institute of Medicine's Crossing the Quality Chasm report, there have been surprisingly few resources available to support the development of "core" healthcare improvement skills. Fewer still have been:

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

We spent several years crafting a set of learning activities and pulling together resources that would meet this need. Subsequently, we focused on the development and piloting of some additional resources, resources intended to provide a warmer welcome and make it yet easier for those new to quality improvement to begin using improvement science concepts, methods and tools in their work. These additional resources have been incorporated in the 3.0 version of the HISC website.

In addition to the six HISC modules, you will now also find tools to help you plan and assess your QI projects, and to assess your QI skills. Recently, a "Concise Practice Improvement Manual" (both abridged and unabridged versions) and a coaching guide have also been added to the site to provide the briefest possible introduction to QI for those new to this work.

The modules can be taken independently, as needed, even as you work on a particular improvement effort. They should furnish 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 activities should find it easier 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.

For several years HISC access for diplomates of the American Board of Internal Medicine, The American Board of Pediatrics and the American Board of Family Medicine to this website was subsidized by these three medical boards in a variety of ways. But now the contents of the entire site are available to all, free of charge.

We ask you to register primarily so that you can easily track your progress through the site. It also allows us to get a sense of how and how much the resources on this site are being used.

How Long Does It Take to Go Through The Six HISC Modules and the other HISC activities?

Completion of each module and most activities will ordinarily take under an hour. Completion of improvement projects, of course, varies. Modest projects, lasting two to three months, are encouraged.


This site is no longer sponsored by an accredited provider of CME credit. When the site was last sponsored for CME credit it was sponsored by the Case Western Reserve University School of Medicine. In addition to the CWRU School of Medicine, over the years the site was for a time also been sponsored by the University of Missouri, Columbia, School of Medicine and the Vanderbilt University School of Medicine.

When sponsored by CWRU, the CME committee consisted of the following individuals:

Kurt Stange, MD, PhDCase Western Reserve University
Mary Dolansky, RN, PhDCase Western Reserve University
Christina Delos-Reyes, MDCase Western Reserve University
Srinivas Merugu, MDCase Western Reserve University
Mark Cheren, EdDCase Western Reserve University and Improvement Learning, LLC

Site Development, Administration & Editorial Oversight
Mark Cheren, EdD    Editor in Chief
HISC v. 3.0 Advisory Board

For several years these four individuals made particularly important contributions to the HISC website in an advisory capacity.

Duncan Neuhauser, PhDCase Western Reserve University
Kurt Stange, MD, PhDCase Western Reserve University
Mary T. Coleman, MD, PhDLouisiana State University
Laurel Simmons, MPHCSI Solutions


We are grateful for the generous support we have received in the development of HISC v. 3.0. Guidance from, and in some cases collaboration with, colleagues Dr. Don Moore, Dr. Paul Miles, Dr. John (Skip) Harris, Dr. David P. Stevens, Dr. Duncan Neuhauser, Dr. Kurt Stange, Laurel Simmons, Sue Butts-Dion, Dr. Sandeep (Sunny) Khosa, Dr. Daniel Duffy, Dr. Susan Stagno, Dr. Srinivas Merugu, Dr. Toni Johnson, Dr. David Aron, Betty Pilous, Nanette Bahlinger, Timothy Sares, Dr. Rebecca Lipner, Elizabeth Blaylock, Dena Fisher, Dr. Aleece Caron, Dr. Mary Dolansky, Dr. Ron Lemmo, Dr. Mimi Singh, Dr. Richard Christie, Dr. Kathy Clegg, Mindy Cheren, Phil Werdell, Dr. Neil Baker, Dr. Mary Coleman and Dr. Chris Delos-Reyes contributed greatly to this effort.

We are particularly indebted to Residency Program Directors Dr. Susan Stagno, Dr. Srinivas Merugu, and Dr. Toni Johnson, along with Dr. Aleece Caron, and their respective teams of faculty coaches and residents, who participated so enthusiastically in piloting of the additional resources and approaches on this expanded site to facilitate a "warmer welcome to QI." Similarly, to Dr. Kurt Stange and Dena Fisher, and area physicians participating in the Northeast Ohio Maintenance of Certification Peer Support Collaborative. The commitment of these professionals to reflective practice contributed a great deal to our understanding of what a warmer welcome to QI can and should mean, and significantly shaped the crafting of this version of the HISC website.

Grants to the afore mentioned pilot projects funded by the Practice-Based Research Micro Grant Program of the Department of Family Medicine, University Hospitals, Case Western Reserve University School of Medicine, and by the Foundation of the American Board of Family Medicine provided substantial support to these efforts. We would like to acknowledge, as well, the substantial value of our ongoing collaborative relationship with the American Board of Internal Medicine.

Please see also, acknowledgement of contributions to the original Modules in the HISTORY section, linked to below

Equipment and Software

  • Use a PC or Macintosh computer.
  • This site is not yet fully functional (and not able to be used) with iPads or other tablet devices.
  • HISC 3.0 supports these browsers:
  • Any problem with them should be considered and reported as a bug to HISC 3.0 Technical Support.

  • JavaScript must be enabled.
  • If you have installed any "pop-up stopper" software, you will need to disable this software before entering any of the modules.
  • Use a monitor with the resolution set to 1024 x 768 pixels or greater.
  • You will need a free copy of Adobe Acrobat Reader (verson 4.0 or higher) installed on your computer to read and download supplemental files.

Show more information about the history of HISC!