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External stakeholder engagement and support
· Patients, community members, collaborative partners, businesses, fellow healthcare agencies, and others
· Collaboration with stakeholders should occur early in the process, and be maintained throughout the planned change process
Evidence-based, best practice standards
· Evidence-based best practice standards should drive policy and protocol at the point of healthcare delivery
· Example-Evidence-based protocol for treatment of emerging infectious disease
Accreditation mandates
· Accreditation bodies such as (The Joint commission) should drive policy, protocol, and practice within healthcare organizations
· Example-National Patient Safety Goals
Federal or state legislative/health policy mandates
· Healthcare legislation will drive healthcare policies, protocol, and practices
· Examples-Patient Protection and Affordable Care Act guidelines
Third party reimbursement regulations
· As healthcare changes, third party reimbursement policies have increased in complexity and specificity
· Example-30 day readmission penalties
External quality directives and benchmarking
· External quality metrics are powerful forces driving change within healthcare organizations
· Examples- HCAHPS, Core Measures, the Value-Based Purchasing Program through Centers for Medicare and Medicaid Services (CMS), and Accountable Care Organizational practices
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