A realist case study of a regional hospital's response to improve emergency department access in the context of Australian healthcare reforms

Introduction: 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.

Objective: This study evaluates how the national reforms have led to improvement in ED access in a regional hospital in remote Australia.Methods: 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.

Results and Conclusion: 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.

Power management and control strategies for efficient operation of a solar power dominated hybrid DC microgrid for remote power applications

In this paper, a hybrid DC microgrid consisting of a diesel generator with a rectifier, a solar photovoltaic (PV) system, and a battery energy storage system is presented in relation to an effective power management strategy and different control techniques are adopted to power electronic interfaces. The solar PV and battery energy storage systems are considered as the main sources of energy sources that supply the load demand on a daily basis whereas the diesel generator is used as a backup for the emergency operation of the microgrid. All system components are connected to a common DC bus through an appropriate power electronics devices (e.g., rectifier systems, DC/DC converter). Also a detailed sizing philosophy of all components along with the energy management strategy is proposed. Energy distribution pattern of each individual component has been conducted based on the monthly basis along with a power management algorithm. The power delivered by the solar PV system and diesel generator is controlled via DC-DC converterand excitation controllers which are designed based on a linearquadratic regulator (LQR) technique as as proportional integral (PI)controllers. The component level power distribution is investigatedusing these controllers under fluctuating load and solar irradiationconditions and comparative results are presented.