Journal of hospital medicine · 2026
Role clarity and organizational capacity as prerequisites for reducing readmissions: Comparing high- and low-performing VA facilities.
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Rattray Nicholas A, Flanagan Mindy E, Donnelly Claire E, Myers Jennifer L, Madrigal Caroline B, Schubert Cathy C, Schwartzkopf Ashley L, Myers Laura J, Jindal Shivani K, Burke Robert E, Leykum Luci K, Anderson Mel L, Hartronft Scotte R, Bravata Dawn M
Аннотация
BACKGROUND: Older adults face a high risk of unplanned hospital readmissions during transitions from hospital to home. Despite system-wide initiatives, substantial variation persists across Veterans Health Administration (VHA) facilities.
OBJECTIVE: To identify organizational factors and transitional care processes associated with high and low readmission rates.
METHODS: We conducted a qualitatively driven explanatory sequential study of 10 VA medical centers selected based on 30-day risk-adjusted readmission rates. Ten facilities (five high-performing, five low-performing) were purposively sampled for qualitative investigation. Semi-structured interviews with clinicians explored discharge planning, communication, and follow-up care. Data were analyzed using rapid qualitative analysis and thematic matrices.
RESULTS: Based on interviews with 54 clinicians, we found that high-performing facilities consistently implemented pharmacist-led medication reconciliation, ensured patients received medications prior to discharge, scheduled follow-up appointments before discharge, and engaged leadership in monitoring readmission metrics. These processes were enabled by organizational conditions such as clear role delineation, effective communication systems, and adequate staffing capacity. Low-performing facilities faced compounding barriers, including unclear accountability, fragmented communication, and capacity constraints that undermined execution despite similar policies.
CONCLUSIONS: Reducing readmissions needs more than clinical protocols; organizational readiness is critical. Investments in team structure, communication protocols, and capacity may yield greater and more sustainable improvements than adding new programs.
OBJECTIVE: To identify organizational factors and transitional care processes associated with high and low readmission rates.
METHODS: We conducted a qualitatively driven explanatory sequential study of 10 VA medical centers selected based on 30-day risk-adjusted readmission rates. Ten facilities (five high-performing, five low-performing) were purposively sampled for qualitative investigation. Semi-structured interviews with clinicians explored discharge planning, communication, and follow-up care. Data were analyzed using rapid qualitative analysis and thematic matrices.
RESULTS: Based on interviews with 54 clinicians, we found that high-performing facilities consistently implemented pharmacist-led medication reconciliation, ensured patients received medications prior to discharge, scheduled follow-up appointments before discharge, and engaged leadership in monitoring readmission metrics. These processes were enabled by organizational conditions such as clear role delineation, effective communication systems, and adequate staffing capacity. Low-performing facilities faced compounding barriers, including unclear accountability, fragmented communication, and capacity constraints that undermined execution despite similar policies.
CONCLUSIONS: Reducing readmissions needs more than clinical protocols; organizational readiness is critical. Investments in team structure, communication protocols, and capacity may yield greater and more sustainable improvements than adding new programs.