The longest running HCRN project has recently been accepted for publication in the Journal of Neurosurgery. The initial four HCRN centers (Primary Children’s Medical Center inSalt Lake City, Children’s Hospital of Alabama in Birmingham, Hospital for Sick Children in Toronto, and Texas Children’s Hospital in Houston) agreed on a standardized protocol for doing shunt surgery. The hypothesis of this quality improvement project was that reducing variation and standardizing the approach across centers would reduce the infection rate. It worked! The centers’ infection rate prior to the protocol was 8.8%, and it fell to 5.7% after the protocol was implemented. This study established initial collaboration and cooperation amongst the HCRN centers and has established a common baseline from which future studies can be launched.