Abstract

The purpose of this article is to analyse the patient demand placed on a rural district general
hospital (DGH) emergency department within the context of the Purpose, Process, People (PPP)
framework used in the private sector. This analysis was undertaken to inform wider evaluation
of the implementation of the enterprise culture—the NHS policy to adopt private sector best
practice to produce resource use, quality and efficiency improvements. The article concludes with
a view that the PPP framework provides methods of calculating the level of discharge necessary
to meet the four-hour wait target. Data describing the characteristics and patterns of attending
patients can be used to develop an emergency department’s processes and people to achieve its
time-based target.