Gold Coast Health Emergency Department load share initiative: Impact on capacity creation, and the experiences of those receiving and delivering care

Background: Many governments across the world rely on public‒private partnerships (PPPs) to deliver infrastructure projects or provide services in the face of fiscal constraints. PPPs have been used as strategic tools in a range of sectors, including healthcare. However, their establishment in the delivery of emergency care has been limited to date. This study explored the performance, cost-effectiveness, and acceptability of a PPP between one public and three private hospitals in Australia to coordinate the distribution of ambulance visits at times of peak demand. Methods: This mixed-methods evaluation combines quantitative data from public health system medical records, financial records, and PPP operational activity records, along with qualitative data from patient experience surveys and interviews across a breadth of public and private hospital staff. The data were triangulated to provide a comprehensive analysis of impact, cost, and value. Results: This PPP to manage emergency demand and enhance regional system-wide demand coordination was considered a high-value initiative and improved patient outcomes and satisfaction. Its effective workflows were underpinned by key enablers. Conclusions: A PPP emergency demand model creates short- to medium-term emergency department capacity at times of high demand.