We believe that the solutions to some of the toughest challenges you face in transitional care can come from your peers—people who are on the front line every day, working to improve the experiences of patients as they transition out of the hospital.
The stories you find here are lessons learned from on-the-ground transitional care implementers. They are not intended to be a substitute for careful program planning, or an evidence-based model for reducing readmissions. The contributors of these stories offer them as tips and tricks that they’ve found effective in helping them overcome challenges and meet their program goals.
They are ideas for inspiring your own solutions, tailored to your own program and patient needs. We hope you find them useful and share your stories, too!
Email your peers to learn more about what they’re doing or establish a mentor-mentee relationship
See a challenge or topic you have a good solution for? Suggest your own high-value strategies to the site
Ask the author a question about the story or add your own tip if you’ve tried something similar
Keep all your favorite stories in one place and share them with your team
Recommend stories that resonate with you, pushing up their popularity so that others can find them
Have a luncheon or webinar you’re hosting? Submit it to the event page to reach a broader audience
Huddle began as a seed of an idea from the Gordon and Betty Moore Foundation. Over the past 10 years, the Moore Foundation’s Betty Irene Moore Nursing Initiative has supported San Francisco Bay Area hospitals to implement evidence-based transitional care programs and reduce readmission rates. As part of these efforts, the Foundation’s partner hospitals joined an Avoiding Readmissions Collaborative where they regularly interacted with each other, sharing their successes and failures. This collaborative allowed these hosptials to gain valuable insights from one another as they overcame key challenges in order to successfully improve the experiences of patients transitioning out of the hospital. Huddle is intended as a forum to allow other transitional care implementers to benefit from this type of collaboration, learning both from these Bay Area hospitals and from each other. Huddle is a project of the Health Research & Educational Trust, supported by the Gordon and Betty Moore Foundation.