Consistent Organizational Structures Associated With Reduced Hospital Readmissions Among US Veterans

Key Takeaways:

• Within the US Department of Veterans Affairs (VA) health system, high-performing facilities had more consistent discharge and subsequent care procedures compared to low-performing facilities.
• Factors such as engaged leadership, effective communication, and adequate staffing helped improve discharge procedures among older adults.
• Subsequent care processes within low-performing centers were impeded by accountability, ineffective communication, and low staffing capacity.

Researchers conducted an exploratory sequential study of VA medical centers to identify organizational factors and procedures associated with hospital readmission rates.

The study analyzed 10 VA facilities, 5 high performing and 5 low performing. In addition, 54 clinicians were interviewed on discharge planning, communication, and follow-up care for older adults transitioning from the hospital to home.

High-Performing vs Low-Performing Facilities

According to interviewees, organizational conditions such as clear role delineation, effective communication systems, adequate staffing capacity, and engaged leadership improved discharge processes in high-performing facilities.

High-performing centers utilized pharmacist-led medication reconciliation to ensure patients received prescribed medications before discharge. Furthermore, clinicians noted that follow-up appointments were scheduled before discharge, potentially increasing rates of subsequent care.

Low-performing centers, on the other hand, faced multiple barriers to enhanced discharge procedures. While these centers might have similar policies to high-performing facilities, poor organizational issues such as unclear accountability, ineffective communication, and capacity constraints may impede subsequent care and lead to poor health outcomes.

Implications for Veteran Care

These findings highlight the significance of organizational structure in carrying out consistent discharge processes, even after the implementation of beneficial policies.

According to the authors, “Investments in team structure, communication protocols, and capacity may yield greater and more sustainable improvements than adding new programs.”

Reference

Rattray NA, Flanagan ME, Donnelly CE, et al. Role clarity and organizational capacity as prerequisites for reducing readmissions: comparing high- and low-performing VA facilities. J Hosp Med. 2026. doi:10.1002/jhm.70447