Internal and external factors in health care guide
Choose a health care organization and complete a three-column table naming ten internal and external factors that affect it, the potential impact of each, and the strategies a manager can use to minimize or control that impact, with 50-100 words per response.
Editorial process
Last reviewed · August 12, 2026
Which organization should you choose?
The format is doing more work than it looks. Ten factors across three columns at fifty to a hundred words each is between fifteen hundred and three thousand words of writing, so the choice of organization decides how hard the rest becomes. Pick something specific enough to have a real environment — a 400-bed community hospital, a rural critical access hospital, a multi-site primary care group, a skilled nursing facility — rather than health care in general. A named organization gives every cell something to attach to: its payer mix, its labour market, its competitors, its regulator, its physical plant. Generic answers are what the rubric is set up to catch, because a table whose rows would fit any organization equally well has not analysed anything, and the fifty-word floor exists to stop one-line entries. Choosing an organization you have worked in is the easiest route, since you already know its pressures and can describe them without inventing detail.
The internal and external split is the part most often got wrong, and the test is control, not location. Internal factors are those the organization can change by its own decision: staffing levels and skill mix, culture and morale, leadership and governance, financial position, information systems, physical plant and equipment, service line composition, and quality performance. External factors are those it can only respond to: reimbursement policy and payer contracts, regulation and accreditation, labour market supply, local demographics and disease burden, competitor behaviour, technology and vendor markets, public health emergencies, and the broader economy. Turnover sits on the boundary and is worth handling carefully — the labour market is external, but whether your organization retains people is internal, and saying so explicitly reads as analysis. Technology behaves the same way: the vendor market is external, while the decision to buy and the quality of the implementation are entirely yours.
The third column is where most of the marks sit and where most answers go vague, so make every strategy something a manager could actually initiate. The useful discipline is to match the strategy to the type of factor. For internal factors, managers can change the thing itself: adjust the staffing model, invest in the system, restructure a service line. For external factors they cannot, so the strategies are different in kind — forecasting and scenario planning, diversifying payer or referral mix, building reserves, contracting and partnership, lobbying and advocacy, and monitoring so the response starts early. Naming the mechanism matters more than naming the intention: reduce agency spend by building an internal float pool is a strategy, whereas improve staffing is a wish, and the difference is visible in a single sentence. Where the same strategy would genuinely serve two factors, say so rather than padding the cell with a reworded duplicate.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Choose one specific organization so every factor has something concrete to attach to.
- 02Sort factors by whether the organization controls them, not by where they originate.
- 03Describe impact in operational terms — cost, staffing, access, quality, volume.
- 04Match the type of strategy to the type of factor.
- 05Write strategies as mechanisms a manager could initiate, not as intentions.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Changing Environment of Health Care DQ Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. 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Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Changing Environment of Health Care DQ
Turn the brief into deliverables
- 01A completed table with ten factors, mixing internal and external.
- 02A 50-100 word impact statement for each factor.
- 03A 50-100 word strategy for each factor, addressed to a manager.
- 04An identified health care organization stated at the top.
How do you sort internal from external?
The organization
Name it and give the few facts that make its environment specific: size, setting, payer mix, service lines.
Internal factors
Cover staffing and skill mix, culture and leadership, financial position, information systems, plant and equipment, and quality performance.
External factors
Cover reimbursement and payer contracts, regulation and accreditation, labour supply, demographics and disease burden, competitors, and technology markets.
Impacts and strategies
State each impact in cost, staffing, access, quality, or volume terms, then give a mechanism matched to whether the factor is controllable.
Where are the health care environment data?
Recommended databases
- CMS
- NCBI Bookshelf
- KFF
Search sequence
- 1.Choose the organization first and write down its size, setting, and payer mix.
- 2.Check national expenditure and cost data for the reimbursement pressures your external rows will cite.
- 3.Read a workforce source for the labour supply factor and its documented effects.
- 4.Draft the table one row at a time, checking each cell against the 50-100 word range.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
National Health Expenditure Data
Centers for Medicare & Medicaid Services · 2024
The reimbursement and cost trends behind the external financial factors and their operational impacts.
- 02
The Nursing Workforce - The Future of Nursing 2020-2030
National Academies of Sciences, Engineering, and Medicine, NCBI Bookshelf · 2021
The labour supply factor — the external market against which internal retention strategies are set.
- 03
Crossing the Quality Chasm
Institute of Medicine, NCBI Bookshelf · 2001
The systems framing for quality performance as an internal factor a manager can act on directly.
Review before submission
Common mistakes
- Choosing health care in general instead of one identifiable organization.
- Sorting factors by where they come from rather than by what the organization controls.
- Listing all ten as external, which leaves nothing a manager can directly change.
- Describing impact as negative or challenging without an operational consequence.
- Offering the same mitigation strategy for internal and external factors alike.
- Writing strategies as intentions — improve morale, increase quality — with no mechanism.
Submission checklist
- Organization named and described in a sentence.
- Ten factors, with both internal and external represented.
- Every impact cell between 50 and 100 words.
- Every strategy cell between 50 and 100 words and initiated by a manager.
- Boundary cases such as turnover explicitly reasoned rather than assigned silently.
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.