Learning From Successful Hospital Discharge: A Realist Evaluation in a Dutch Hospital to Gain Insight Into Its Underlying Working Mechanisms.

OBJECTIVE To understand the underlying working mechanisms and the influencing context of successful discharge.

METHODS We conducted a realist evaluation using observations, individual interviews, and focus group interviews with both patients and different types of health care professionals involved in the discharge process on a ward where discharge was perceived to be successful. Using framework analysis, we developed an initial program theory to capture the working mechanisms that contribute to a successful hospital discharge.

RESULTS We found 3 underlying working mechanisms that were triggered and influenced by context, contributing to successful hospital discharges in daily practice: to anticipate, to connect, and to simplify.

CONCLUSIONS We illustrate how successful discharge is achieved through the underlying working mechanisms-to anticipate, to connect, and to simplify-that are triggered by the context encountered. Our findings show that to ensure successful discharges, policies and protocols for health care professionals should be flexible and adaptable to daily variations in context.