Date of Conferral

7-4-2025

Degree

Ph.D.

School

Public Policy and Administration

Advisor

Anne Hacker

Abstract

The Hospital Readmissions Reduction Program (HRRP), developed by the Centers for Medicare and Medicaid Services, aims to reduce avoidable readmissions through financial penalties. While HRRP has been associated with modest reductions in readmissions, it has also been linked to the problem of unintended outcomes such as increased mortality and inequitable penalties for hospitals serving socioeconomically disadvantaged populations. The literature presents a limited understanding of how hospital-based healthcare professionals (HHPs) implement HRRP. The purpose of this generic qualitative study was to explore how HHPs perceive the implementation of HRRP requirements and the barriers and facilitators that influence compliance. Grounded in Lipsky’s street-level bureaucracy theory and Morçöl’s presentation of complexity theory, this study was guided by the research question that asked what the perceptions were of HHPs regarding the implementation, barriers, and facilitators related to HRRP targets. Interviews were conducted with 15 HHPs, and the data were analyzed using Braun and Clarke’s six-phase thematic analysis. Four themes emerged: (a) navigating complex administrative pressures, (b) the role of cross-setting coordination, (c) the importance of individualized patient engagement, and (d) systemic and resource-based constraints that complicate implementation. These findings may support more realistic and equitable policy design by clarifying how HRRP is interpreted in practice. Implications for positive social change include potentially improving healthcare outcomes and informing policymakers on context-sensitive approaches to policy design and evaluation.

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