A Realist Case Study of Alice Springs Hospital’s Response to Improve Emergency Department Access in the Context of National Healthcare Reforms (Why and How Alice Springs Hospital improved their emergency department access)

Author: Sandeep Reddy

Reddy, Sandeep, 2016 A Realist Case Study of Alice Springs Hospital’s Response to Improve Emergency Department Access in the Context of National Healthcare Reforms (Why and How Alice Springs Hospital improved their emergency department access), Flinders University, School of Medicine

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Abstract

In the past few years, Australia has embarked on major health care reforms extending across all states and territories. While reform implementation has slowed, increased funding and targets have had some impact on the public hospital sector. However, evidence linking national reforms to improved performance in public hospitals is meager. This absence is even more pronounced in the case of regional hospital performance. This study evaluated whether national reforms have led to an improvement in emergency department (ED) access (an important hospital performance measure) in a regional hospital in Central Australia, Alice Springs Hospital. The study identified moderate improvement in ED access as a result of reform investment in infrastructure and workforce, and introduction of ED targets. Clinical leadership and support from the hospital management and the federal government has been critical for the improvement. However, infrastructure and workforce funding must be accompanied by clinical redesign activities for improvement to be sustained. The study also identified that reform funding has to be equitable within a hospital, and be provided on a long-term basis in order to be effective. In the context of a paucity of research on the impact of national healthcare reforms on regional and remote hospital performance, this study sheds some light on pathways that are critical for improvement in ED access.

Keywords: Healthcare Reform, Hospital Performance, Regional Hospitals, Realist Evaluation, Realist Case Study, Emergency Department, Change Management
Subject: Health Service Management thesis, Public Health thesis, Primary Health Care thesis, Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2016
School: School of Medicine
Supervisor: Professor Tim Carey