Objective: Environmental factors have changed the manner in which issues in the U.S. healthcare industry are addressed. One of these changes is in the area of quality improvement, specifically readmission reduction. The purpose of this paper is two-fold: (1) analyze macro-environmental segments (political, technological, economic, and socio-demographic); and (2) trace the historic evolution of readmission reduction programs to understand how macro-environmental factors have shaped the development of readmission reduction strategies.Methods: Scopus, PubMed, and ABI/Inform electronic databases were searched for articles on readmission reduction programs from 2000 to 2014. In addition, literature on macro-environment was retrieved from these sources for the same time period. Studies were identified using specific search terms and inclusion criteria. A total of 24 articles were selected for review. Data on the following variables were extracted: type of organization studied, type of quality improvement strategy used, type of patients studied, and results of the strategy. In addition, an examination of macro-environmental factors that may have affected the above variables was done. Finally, results were integrated and presented in a chronological order.Results: Findings suggest that macro-environmental factors have influenced the development of readmission reduction strategies over time. This paper informs healthcare managers about being cognizant of environmental trends when devising readmission reduction strategies within hospitals.Conclusions: Insights from this paper urge hospital administrators to forge collaborations with key stakeholders while developing new quality improvement strategies when facing an unstable and complex environment.