Internal and External Forces of Change in a Hospital Readmission

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There are some factors, both internal and external, that are likely to affect the implementation of the Hospital Readmission change project. One of the external barriers is the organizational commitment towards other long-term priorities. Besides the Hospital Readmission change project, there may be other strategic priorities that the organization could be pursuing. Since these other policy priorities require resources, time, and management attention, there may be a struggle for resources between the implementation of Hospital Readmission project and other projects. Just like any other tasks, Hospital Readmission change project requires resources for its successful implementation. In a situation where the resources, be it money or time are inadequate, implementation of the project becomes difficult. External forces that may affect implementation of Hospital Readmission change project include lack of accountability from stakeholders and higher expectations for completion of the implementation of Hospital Readmission change project by these external stakeholders.

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A proposed change to address the problem of hospital readmission is changing the way healthcare is delivered to patients. The procedures and methods that are used to provide quality care to patients should be improved and digitalized. Therefore, there should be channels through which patients can communicate to the hospital, for example, through phone calls to enquire more about their conditions that may require hospitalization. The internal obstacle to this change is a lack of adequate representatives to answer to these appeals. External forces include communication barriers between the hospital staffs and patients. However, these challenges can be addressed by ensuring that adequate personnel that are familiar with different languages are available to answer patient queries.

An example of an organization facing a challenge similar to Hospital readmission problem is the Mayo clinic which specialized in dealing with difficult cases through tertiary care, with its main branches in Florida and Arizona. Notably, high patient population is a major problem facing this clinic with the majority of patients being referrals from small clinics (Fonarow, Stevenson, Walden, et al. 1997)

The driving forces to balancing the problem of high patient population in Mayo Clinic include the availability of enough resources to carry out research and implement changes. Mayo Clinic spends $500 million on research annually. This availability of funds is a major driving force in facilitating the change. Another driving force is the availability of highly qualified and a large number of staff. Since the implementation of change requires trained personnel, Mayo Clinic has an advantage as far as change application is concerned due to their highly qualified and adequate caregivers. The forces inhibiting change in the case of Mayo Clinic is the nature of their clinics and services which are widespread across various locations. Decentralization of activities in this clinic may hinder its attempt to reduce the high number of the patient population since coordination of change activities in all the hospitals is difficult (Koehle, Richter, Youngblood et al. 2009).

In order to address the challenge of a high patient population, the clinic has employed high qualified and adequate staffs who are capable of attending to patients within the shortest period and offering high-quality care. When patients are attended to within a short period and given quality care, they are discharged faster, and the possibility of complete treatment is high. This ensures that they do not stay in the hospitals for long. The problem of external shareholders who are located in various places that the clinic has branches is addressed by centralizing change implementation activities at the main branches of the hospital.

The actions taken by Mayo Clinic in addressing their challenges can be applied in the case of Hospital readmission change project. The first action that is most suitable is the acquisition of highly qualified and adequate staffs that are capable of offering quality care to patients thus ensuring they get completely healed and will not be readmitted back to the hospital for some time. The action of centralizing change activities can also be applied where hospitals concentrate the change activities in one department so as to ensure that maximum attention is given to the change process.


Anderson, H. R. (1989). Increase in hospital admissions for childhood asthma: trends in referral, severity, and readmissions from 1970 to 1985 in a health region of the United Kingdom. Thorax, 44(8), 614-619.

Fonarow, G. C., Stevenson, L. W., Walden, J. A., Livingston, N. A., Steimle, A. E., Hamilton, M. A., ... & Woo, M. A. (1997). Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure Journal of the American College of Cardiology, 30(3), 725-732

Koehler, B. E., Richter, K. M., Youngblood, L., Cohen, B. A., Prengler, I. D., Cheng, D., & Masica, A. L. (2009). Reduction of 30day postdischarge hospital readmission or emergency department (ED) visit rates in highrisk elderly medical patients through delivery of a targeted care bundle. Journal of Hospital Medicine, 4(4), 211-218.

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