BackgroundIn 2009, the New Zealand government introduced a hospital emergency department (ED) target – 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when.MethodsWe adopted a mixed-methods approach with integration of data sources. After selecting four hospitals as case study sites, we collected all ED utilisation data for the period 2006 to 2012. ED LOS data was derived in two forms-reported ED LOS, and total ED LOS - which included time spent in short-stay units. This data was used to identify changes in the length of ED stay, and describe the timing of these changes to these indicators. Sixty-eight semi-structured interviews and two surveys of hospital clinicians and managers were conducted between 2011 and 2013. This data was then explored to identify factors that could account for ED LOS changes and their timing.ResultsReported ED LOS reduced in all sites after the introduction of the target, and continued to reduce in 2011 and 2012. However, total ED LOS only decreased from 2008 to 2010, and did not reduce further in any hospital. Increased use of short-stay units largely accounted for these differences. Interview and survey data showed changes to improve patient flow were introduced in the early implementation period, whereas increased ED resources, better information systems to monitor target performance, and leadership and social marketing strategies mainly took throughout 2011 and 2012 when total ED LOS was not reducing.ConclusionsWhile the ED target clearly stimulated improvements in patient flow, our analysis also questions the value of ED targets as a long term approach. Increased use of short-stay units suggests that the target became less effective in ‘standing for’ improved timeliness of hospital care in response to increasing acute demand. As such, the overall challenges in managing demand for acute and urgent care in New Zealand hospitals remain.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2617-1) contains supplementary material, which is available to authorized users.

The importance of evaluation use has led to a large amount of theoretical and empirical study. Evaluation use, however, is still not well understood. There is a need to capture the complexity of this phenomenon across a diverse range of contexts. In response to such complexities, the notion of ''evaluation influence'' emerged. This article presents a theory of evaluation influence within public sector partnerships. An analysis of key concepts is used to develop propositions about the relationships between evaluation attributes, partnership functioning and characteristics, partnership evaluation behavior, individual characteristics, contextual factors, and evaluation influence. The model highlights the complexities of evaluation influence and identifies a range of factors that evaluators can consider in practice. The model also extends on existing theories of evaluation influence in considering the role of individual characteristics, stakeholder evaluation behavior, and partnership contexts.

Evaluating the outcomes of social-change initiatives is often conceptualised as a long-term endeavour, where the impacts take some years to assess. This is feasible for large-scale, multiyear initiatives, but challenging for relatively small-scale, community-based projects with short-term funding cycles. This article discusses the evaluation techniques developed to work with a range of short-term community projects funded through two national social-change campaigns to address bullying, and the exclusion of disabled people, in Aotearoa New Zealand. Drawing primarily on developmental evaluation and supported by results-based accountability (RBA), the evaluators provided evaluation support and capability building to community projects to support their development journeys and accountability requirements. We draw on our reflections and learning to identify the value of this approach, as well as the challenges and tensions that emerged from integrating developmental evaluation and RBA. Implications for practice are highlighted through these discussions. Accountability and development? Supporting provider-led evaluation of short-term community social-change projects