The value of cooperatives in rural electrification

The electricity sectors of many developing countries underwent substantial reforms during the 1980s and 1990s, driven by global agendas of privatization and liberalization. However, rural electrification offered little by way of market incentives for profit-seeking private companies and was often neglected. As a consequence, delivery models for rural electrification need to change. This paper will review the experiences of various rural electrification delivery models that have been established in developing countries, including concessionary models, dealership approaches and the strengthening of small and medium-sized energy businesses. It will use examples from the USA, Bangladesh and Nepal, together with a detailed case study of a Nepali rural electric cooperative, to explore the role that local cooperatives can play in extending electricity access. It is shown that although there is no magic bullet solution to deliver rural electrification, if offered appropriate financial and institutional support, socially orientated cooperative businesses can be a willing, efficient and effective means of extending and managing rural electricity services. It is expected that this paper will be of particular value to policy-makers, donors, project planners and implementers currently working in the field of rural electrification. © 2010 Elsevier Ltd.

Low-carbon off-grid electrification for rural areas in the United Kingdom: Lessons from the developing world

Low-carbon off-grid electrification for rural areas is becoming increasingly popular in the United Kingdom. However, many developing countries have been electrifying their rural areas in this way for decades. Case study fieldwork in Nepal and findings from United Kingdom based research will be used to examine how developed nations can learn from the experience of developing countries with regard to the institutional environment and delivery approach adopted in renewable energy off-grid rural electrification. A clearer institutional framework and more direct external assistance during project development are advised. External coordinators should also engage the community in a mobilization process a priori to help alleviate internal conflicts of interest that could later impede a project. © 2011 Elsevier Ltd.

Stress on the ward: evidence of safety tipping points in hospitals

Do hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

Low-carbon off-grid electrification for rural areas: Lessons from the developing world

Low-carbon off-grid electrification for rural areas is becoming increasingly popular in developed nations such as the United Kingdom. However, many developing countries have been electrifying their rural areas in this way for decades. Case study fieldwork in Nepal and findings from UK-based research will be used to examine how developed nations can learn from the experience of developing countries with regards the institutional environment and delivery approach adopted in renewable energy off-grid rural electrification. A clearer institutional framework and more direct external assistance during project development are advised. External coordinators should also engage the community in a mobilization process a priori to help alleviate internal conflicts of interest that could later impede a project. ©2010 IEEE.

The user-value of rural electrification: An analysis and adoption of existing models and theories

User-value is a determining factor for product acceptance in product design. Research on rural electrification to date, however, does not draw sufficient attention to the importance of user-value with regard to the overall success of a project. This is evident from the analysis of project reports and applicable indicators from agencies active in the sector. Learning from the design, psychology and sociology literatures, it is important that rural electrification projects incorporate the value perception of the end-user and extend their success beyond the commonly used criteria of financial value, the appropriateness of the technology, capacity building and technology uptake. Creating value for the end-user is particularly important for project acceptance and the sustainability of a scheme once it has been handed over to the local community. In this research paper, existing theories and models of value-theory are transposed and applied to community operated rural electrification schemes and a user-value framework is developed. Furthermore, the importance of value to the end-user is clarified. Current literature on product design reveals that user-value has different properties, many of which are applicable to rural electrification. Five value pillars and their sub-categories important for the users of rural electrification projects are identified, namely: functional; social significance; epistemic; emotional; and cultural values. These pillars provide the main structure for the conceptual framework developed in this research paper. It is proposed that by targeting the values of the end-user, the key factors of user-value applicable to rural electrification projects will be identified and the sustainability of the project will be better ensured. © 2014 The Authors.