Leading Better Value Care Program

Commencing in 2017/18, the NSW Health system started to move away from the traditional approach of measuring value in terms of volume/output in relation to costs, to measuring value in terms of the Institute for Healthcare Improvement Quadruple Aim of health outcomes, experience of patients, experience of providers and effective and efficient care (in relation to costs). In this context, health outcomes are defined as the outcomes that matter to patients. A key goal is to improve value for patients and in doing so, unite the interest of all health care system stakeholders (e.g. patients and their families, NSW residents, clinicians, LHD/SHN, Pillars and the Ministry of Health (MoH)).

Better Value Care is one of the key priorities for NSW Health. Leading Better Value Care (LBVC) seeks to identify and implement opportunities for delivering value based care  to the people of NSW. The program uses a systematic approach, embedding good practice and measuring care, experiences and health outcomes. Opportunities are grouped into three categories: Clinical Initiatives, Commissioning and Contestability, and Workforce Capability. As immediate priorities, 13 initiatives have been selected which align to existing work efforts that have been “road-tested” to varying degrees across the system.

The thirteen clinical initiatives, supported by a Pillar organisation (the Agency for Clinical Innovation, the Clinical Excellence Commission or the Cancer Institute NSW), introduce new or improved models of care for:

  1. Management of Osteoarthritis (ACI)
  2. Osteoporotic Refracture Prevention (ACI)
  3. Diabetes High Risk Foot Services (ACI)
  4. Inpatient Management of Diabetes Mellitus (ACI)
  5. Management of Chronic Heart Failure (ACI)
  6. Management of Chronic Obstructive Pulmonary Disease (ACI)
  7. Renal Supportive Care (End Stage Kidney Disease (ACI)
  8. Falls in Hospitals (CEC)
  9. Bronchiolitis (ACI)
  10. Hip Fracture Care (ACI)
  11. Wound management (ACI)
  12. Direct Access Colonoscopy (CINSW)
  13. Hypofractionated Radiotherapy for Early Stage Breast Cancer (CINSW)

Shared priorities

A key goal of the LBVC Program is to create shared priorities across the NSW health system so that the system works together to improve health outcomes, to improve the experience of receiving and providing care and deliver efficient and effective care. The main components of this approach include the following.

Presentation by Elizabeth Koff, NSW Health and Medical Research Exchange, 7 November 2016 | View slides

Monitoring and evaluation approach for Leading Better Value Care Clinical Initiatives

Background and purpose

Evaluation is an essential aspect of all Leading Better Value Care Clinical Initiatives. Rigorous evaluation will assess the quantum of benefits achieved for each initiaitve, enabling informed decision making around investment, reinvestment and disinvestment.

This approach is consistent with addressing the findings in the NSW Auditor General’s Report (November 2016) that notes that Government decision-makers are not receiving enough information to make evidence-based investment choices, and there is little assurance that the right programs are being evaluated. Being a priority for NSW Health and pillar agencies, the clinical initiatives are key areas for evaluation to ensure NSW is meeting its targets in placing the focus of healthcare on value rather than volume through improving patient outcomes, patient and staff experience of care provision and the subsequent effectiveness and efficiency of that care.


The primary objectives of evaluating the clinical initiatives are to examine the impact of the clinical initiatives focussing on the quadruple aim. This will take into account the focus of:

The evaluation will necessarily be connected to the healthcare system to enable effective development, monitoring, performance and using evaluation results to further inform improvements in the system. This will comprise:

To achieve these objectives, one set of data are required to ensure consistency and to ensure that there is no duplication. The data will be comprehensive to enable different uses for the various subsets of evaluation including Roadmap milestone measures and Performance reporting systems. A logical sequencing of evaluation inclusive of feedback loops will be planned in the development stage to ensure the above objectives can be met. Thus, evaluation is inherently linked to program design and where feasible, will be a key focus from program design and inception to ensure appropriate focus, measures and linkages are in place.

Diagram showing an overview of evaluation sequencing
Figure 1 shows an overview of evaluation sequencing.


To provide maximum results, all programs will undergo an evaluability assessment to assess the readiness of sites to participate in program implementation and evaluation and enable inter-site comparisons. Evaluation planning will include the development of monitoring systems that systematically assess the progress of a program towards achieving outcomes. Monitoring measures will be based on financial reporting and implementation milestones and be assessed through Roadmaps of the lead Pillar Agency (ACI, CEC or CINSW). Although essential to assess implementation strategies and underlying program theories to determine the extent in which a program is in place and the local contexts, the predominant focus of evaluation will be on the impact of the programs using the quadruple aim as the key underpinning. This monitoring will be a sub-set of evaluation. Performance reporting will be another sub-set of evaluation and use the same dataset. This will be reported through Service Agreements between the MoH and the Local Health Districts/Specialty Health Networks or with the participating Pillar Agencies.


Monitoring processes will be provided to the MoH through the Roadmaps processes and improvement plans developed where required. Service Agreements will reflect the performance reporting requirements. Results of impact evaluations will be provided to the Senior Executive Forum to contribute to decision making processes.

shows a high level overview of the monitoring and evaluation approach for the clinical initiatives
Figure 2 shows a high level overview of the monitoring and evaluation approach for the clinical initiatives.

i http://www.audit.nsw.gov.au/news/implementation-of-the-nsw-government-s-program-evaluation-initiative

Last updated: 17 Dec 2020

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