Houston-Based Hospital Reduces Readmissions with Society of Hospital Medicine's Project BOOST


Change doesn’t always come easily to hospitals, but once a catalyst comes along, one positive change can set the stage for the next one—and the one after that. At least that’s the lesson from Houston Methodist Hospital (HMH) and their work with SHM’s Project BOOST, a yearlong, mentored implementation program designed to help hospitals nationwide reduce readmission rates.

As the saying goes, every journey begins with a single step. For hospitals ready to start their journey to reduce readmissions rates and tackle other quality improvement challenges, the first step is the application to Project BOOST, which is due at the end of August. Details on the application and fees are available at www.hospitalmedicine.org/boost.

At Houston Methodist Hospital—a hospital U.S. News & World Report ranked one of “America’s Best Hospitals” in a dozen specialties and designated as a magnet hospital for excellence in nursing—taking that first step toward reducing readmissions by applying to Project BOOST has been well worth it.

“I recommend Project BOOST enthusiastically and unequivocally. If implemented efficiently, it could result in a ‘win-win’ situation for patients, the hospital, and the healthcare providers,” says Manasi Kekan, MD, MS, FACP, who serves as HMH’s medical director. “As a hospitalist, at times, I have found it challenging to ration my times between patient contact and documentation to meet the goals set by the healthcare industry. Being involved in BOOST and watching tangible improvements for my patients has provided me with immense personal and professional gratification!”

In fact, Dr. Kekan and her team have been so pleased with the results, both quantitative and qualitative, from their participation in Project BOOST that they enrolled twice: first in 2012 and again in 2013. She cites the program’s adaptability “that would help us develop a higher quality discharge process for our patients.”

Like many fruitful journeys, though, this one did not find Dr. Kekan and the caregivers at HMH alone: They had a guide who made all the difference.

Change implementation can be difficult, says Houston Methodist’s Janice Finder, RN, MSN. “Everyone knows how they want to design the house, so to speak,” she says, “but if you have someone who has done it before and can lead and direct, it goes much smoother.”

That was the true value of their Project BOOST mentor, Jeffrey Greenwald, MD, SFHM, one of the founding developers of Project BOOST.

“Dr. Greenwald gave us great mentorship and guidance,” Finder says. “The guidance about leadership is essential. If you do not have full support and a person who has ‘been there, done that,’ it is hard to envision.”

From his perspective, Dr. Greenwald saw that HMH had many of the critical elements in place to be successful.

“They had a good set of experiences already. They had the will and leadership and skill on the ground in process improvement,” he says, calling HMH an “incredibly well-oiled machine” with buy-in from the kind of inter-professional team that can make Project BOOST a success.

Overall, Dr. Greenwald calls HMH a “good example of a hospital that has married Project BOOST with the hospital’s existing priorities.”

Other Project BOOST sites start at different levels, in terms of basic interventions and process improvement, Dr. Greenwald explains. Many are able to address more advanced challenges, like how to implement change across broader areas in the hospital, working with leadership, addressing political issues, and improving waning interest in groups.

Dr. Greenwald’s interest in mentorship of Project BOOST sites stems from his own experiences early on—and the need for mentors in quality improvement projects.

“I wish I would have had someone like that when I got started,” says Dr. Greenwald, who tries to fill that role for others now. “Hopefully, each group moves down the path of making sure they have the right stakeholders, the right communications styles and skills in how to look at data and work with front-end staff.”

While Project BOOST focuses teams on reducing readmissions rates, Dr. Kekan has found that the skills learned from Project BOOST have created a blueprint that is applicable to many other team-based challenges in the hospital.

“We describe BOOST as a patient-centric quality initiative that mainly helps improve care transitions and encourages patients to stay informed about their health, which, in turn, helps reduce readmissions,” she says. “BOOST can be used as a framework to enhance other disease-specific discharge initiatives, like CHF [congestive heart failure] and delirium.”

Still, the core elements of reducing readmission rates and making a qualitative impact on her, her team, and the hospital resonate the most with Dr. Kekan.

“Providing a good transition plan to our patients provides satisfaction like none other.”

Brendon Shank is SHM’s associate vice president of communications.

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