Reddy Sandeep, Carey Timothy A, Wakerman John
Centre for Remote Health, a Joint Centre of Flinders University and Charles Darwin University, Alice Springs, Northern Territory, Australia.
Flinders NT, Flinders University, Darwin, Northern Territory, Australia.
Health Serv Res Manag Epidemiol. 2016 Feb 15;3:2333392816631101. doi: 10.1177/2333392816631101. eCollection 2016 Jan-Dec.
Major health-care reforms have extended across all Australian public hospitals in recent years. Improving emergency department (ED) access has been a focus of these reforms.
This study evaluates how the national reforms have led to improvement in ED access in a regional hospital in remote Australia.
Assessing a complex scenario such as national reforms and the challenges faced by the regional hospital to implement these reforms requires in-depth analysis. A realist evaluation theory-based approach was employed, allowing investigation of what, how, why, and for whom change occurred. A case study mixed methods design was adopted within the realist framework to answer these questions about change.
The study identified moderate improvement in ED access as a result of the reforms (investment in infrastructure and workforce and the introduction of ED targets). Clinical leadership and support from management were essential for the improvement. Without ongoing investment and clinical redesign activities, however, sustainability of the improvement may prove difficult.
近年来，重大医疗改革已在澳大利亚所有公立医院全面推行。改善急诊科（ED）的就医机会一直是这些改革的重点。
本研究评估国家改革如何促使澳大利亚偏远地区一家区域医院的急诊科就医机会得到改善。
评估诸如国家改革这样的复杂情况以及区域医院在实施这些改革时面临的挑战需要深入分析。采用了基于现实主义评价理论的方法，以便调查变革发生了什么、如何发生、为何发生以及针对何人发生。在现实主义框架内采用了案例研究混合方法设计来回答这些关于变革的问题。
研究发现，改革（对基础设施和劳动力的投资以及引入急诊科目标）使急诊科就医机会有适度改善。临床领导力和管理层的支持对这种改善至关重要。然而，如果没有持续的投资和临床重新设计活动，这种改善的可持续性可能会很困难。
