Barriers and Facilitators to Implementing Project Boost to Improve the Discharge Process

Background:

Project BOOST (Better Outcomes for Older adults through Safe Transitions) is being implemented at 30 U.S. hospitals to enhance the hospital discharge process. Pilot sites began implementing Project BOOST'S core elements in January 2009. However, given that previous research has shown that quality improvement interventions to speed implementation of evidence‐based best practice are implemented with variable success, we evaluated the experience of barriers and facilitators to BOOST implementation among the 6 pilot sites in the first year of participation.

Methods:

We used content analysis to synthesize data from BOOST program application materials, Project BOOST online community discussions, and structured phone interviews with project leaders from each site of the 6 pilot sites. Interview questions were developed based on a modified Delphi method, and consisted of 15 questions on topics that ranged from basic implementation status questions to opinions on efficacy of various elements of BOOST.

Results:

Our analysis identified 2 themes describing barriers and 2 themes describing facilitators related to BOOST implementation, Although study sites each reported that protected time would be allotted to Project BOOST during the application process, interviews revealed that most sites lacked such protected time and had added BOOST responsibilities on top of their regular duties. In addition, sites equated their lack of time for BOOST activities with difficulty keeping BOOST goals “on the marquees” at their institution. This quote reflects sentiments among site leaders that maintaining senior management support for the project has been difficult and, particularly at academic sites, alternative efforts to reduce readmission were found to “compete” with Project BOOST tools. One academic site slated, “The project had trouble getting momentum. People were not excited … about transitions in care. [They] thought it would interfere with their own efforts.” Sites also discussed several factors they believed had contributed to successes around implementation. First, sites identified mentoring from Project BOOST as an essential facilitator of implementation. They reported that mentors kept them accountable (i.e., on a time line) and participated in site‐specific problem‐solving. In addition, sites believed BOOST was capable of catalyzing the formation of collaborative working groups, described as “a team atmosphere” by 1 site leader. Although a lack of collaboration was described as a barrier to implementation, sites believed that BOOST membership had bridged these differences at some sites.

Conclusions:

Evaluation of the 6 BOOST pilot sites found both facilitators and barriers to successful implementation. Project BOOST site mentors were identified as essential resources for overcoming site‐specific barriers. However, mentors' contribution was largely targeted at process improvement and sites continued to struggle to build institutional support, particularly for the replacement of existing protocols.

Author Disclosure:

L. Hansen, none; V. Forth, none; T. Budnitz, none; J. Greenwald, none; E. Howell, none; G. Maynard, none; L. Halasyamani, none; K. Kerr, none; A. Vidyarthia, none; E. Coleman, none.