Analysis of Centralized Efficiency Improvement Practices in Australian Public Health Systems

Figures & data

Box 1 Search Strategy

NSW Health NSW Health Agency for Clinical Innovation NSW Clinical Excellence Commission eHealth NSW HealthShare NSW Australian Government Department of Health Australian Digital Health Agency Australian Independent Hospital Pricing Authority Australian National Health Funding Body Victoria Department of Health (Previously Victoria Health and Human Services) Safer Care Victoria Queensland Health Northern Territory Health Western Australia Department of Health Western Australia Health Support Services South Australia Health ACT Health Tasmanian Department of Health Grattan Institute Australian Government Productivity Commission Australian Health Research Alliance

Table 1 List of Included Documents

Document Source	Document Name	Year
NSW Agency for Clinical Innovation	Understanding program evaluation: An ACI Framework^Citation29	2013
NSW Agency for Clinical Innovation	Understanding the use of health economics: An ACI Framework^Citation30	2013
NSW Agency for Clinical Innovation	Knowledge management: An ACI approach^Citation31	2013
ACT Health	ACT Health Directorate Strategic Plan 2020–25^Citation32	2019
ACT Health	ACT Health Governance Framework 2018–2023^Citation33	2018
Australian Digital Health Agency	Australia’s National Digital Health Strategy^Citation34	2017
Australian Department of Health	ADDENDUM TO NATIONAL HEALTH REFORM AGREEMENT 2020–2025^Citation35	2020
Independent Hospital Pricing Authority	Pricing Framework for Australian Public Hospital Services 2022–23^Citation36	2021
NSW Health Clinical Excellence Commission	Healthcare Safety and Quality Capabilities^Citation37	2021
NSW Health	NSW Health Analytics Framework^Citation38	2016
eHealth NSW	eHealth Strategy for NSW Health 2016–2026^Citation39	2016
NSW Healthshare	HealthShare Strategic Plan 2020–2024^Citation40	2020
NSW Health	NSW Health Commissioning for Better Value Strategy 2021–24^Citation41	2021
NSW Health	Financial Requirements and Conditions of Subsidy (Government Grants)^Citation42	2021
NSW Health	NSW Framework for New Health Technologies and Specialised Services^Citation43	2018
NSW Health	Future Health: Guiding the next decade of care in NSW 2022–2032^Citation44	2022
NSW Health	HEALTH PROFESSIONALS WORKFORCE PLAN 2012–2022 REVISED 2015^Citation45	2015
NSW Health	RESOURCE EFFICIENCY STRATEGY 2016 TO 2023^Citation46	2016
NSW Health	Corporate governance and accountability compendium- Section 7 Finance^Citation47	2019
Northern Territory Health	NT HEALTH WORKFORCE STRATEGY 2019–2022^Citation48	2019
Northern Territory Health	Strategic plan 2018–2022^Citation49	2018
Northern Territory Health	Service Plan 2021–22: NT Regional Health Services Plan^Citation50	2021
Northern Territory Health	Service Plan 2021–2022: Performance Framework^Citation51	2021
Queensland Health	Optimising the allied health workforce for best care and best value^Citation52	2019
Queensland Health	Destination 2030: Great Care for Central Queenslanders^Citation53	2017
Queensland Health	Queensland Health Performance and Accountability Framework 2020–2021^Citation54	2020
Queensland Health	System Outlook to 2026 for a sustainable health service^Citation55	2016
Queensland Health	Digital Health 2031: A digital vision for Queensland’s health system^Citation56	2021
South Australia Health	SA Health Performance Framework^Citation57	2021
South Australia Health	State Public Health Plan 2019–2024^Citation58	2018
Tasmanian Department of Health	Digital Health Transformation – Improving Patient Outcomes^Citation59	2022
Tasmanian Department of Health	Health Workforce 2040^Citation60	2021
Tasmanian Department of Health	Tasmanian Health Service 2020–21 Service Plan (May 2021 Amendment)^Citation61	2021
Victoria Health and Human Services	Decision making framework for funding policy^Citation62	2016
Victoria Health and Human Services	Policy and funding guidelines 2020–21 Policy guide^Citation63	2020
Victoria Health and Human Services	CAPABILITY FOR INNOVATION AND IMPROVEMENT STRATEGY 2017–20^Citation64	2017
Victoria Health and Human Services	Victorian health services Performance Monitoring Framework 2019–20^Citation65	2019
Western Australia Department of Health	Clinical Services Framework 2020 Addendum^Citation66	2021
Western Australia Department of Health	2021–22 Key Performance Indicators (KPIs) and Targets^Citation67	2021
Western Australia Department of Health	Better health, better care, better value WA Health Reform Program 2015–2020^Citation68	2015
Australian Health Research Alliance	AHRA: National Framework for Health Systems Improvement and Sustainability 2018^Citation69	2018
Grattan Institute	Incentives for efficiency^Citation70	2021
Australian Government Productivity Commission	Efficiency in Health^Citation71	2015

Box 2 Definitions of Efficiency

Allocation of resources to provide best outcomes^Citation71 Cost effectiveness^Citation71 Extent to which the inputs used to produce a given output are minimised^Citation71 The right mix of health outputs is being produced^Citation71 Delivering services within allocated budgets^Citation68 Ensuring value for money^Citation68 Achieving financial sustainability^Citation68 Effectiveness and efficiency of outcomes and services against key indicators^Citation68 Efficient and effective allocation of resources to deliver safe and cost-effective services^Citation65 Ensuring best use of resources to further the aims of the organisation^Citation33 Management of cost and environmental impact^Citation46 Management of time and resources^Citation72 Maximised service capacity and capability^Citation55 Resource utilisation^Citation47 Deliver the best value from available resources (Technical efficiency)^Citation29 Making the right decisions about how to use resources to maximise health and wellbeing over time^Citation71 Ensure the right combination and number of services are being achieved (Allocative efficiency)^Citation62 Available resources are maximised to deliver sustainable, high-quality health care^Citation54 The right care is delivered at a minimum cost and human and physical capital and technology are maintained and renewed, while innovation occurs to improve efficiency and respond to emerging needs^Citation61 Resources are optimally used and managed to deliver sustainable, high-quality health care and services evidence strong financial accountability and sustained successful budget management^Citation57

Table 2 Summary of System-Level Management Approaches to EI

Approach Theme	Specific Approaches Identified
Establish strategic priorities for improving efficiency	Establish efficiency and financial sustainability as strategic priorities^Citation35,Citation44,Citation49,Citation53,Citation61,Citation63 Deliver quality, cost and experience requirements concurrently by setting a whole-of-system focus driven at a local level^Citation66
Embed EI in performance management frameworks and measures	Establish EI performance measures and targets within performance frameworks^Citation42,Citation47,Citation54,Citation57,Citation65,Citation67 Establish planning and performance monitoring frameworks^Citation32 Establish a central Performance, Reporting and Data division^Citation33 Establish efficiency benchmarking and reporting standards^Citation68
Improve infrastructure efficiency	Provide cost-effective technological infrastructure^Citation34,Citation39 Develop a plan for effective and efficient physical resource use^Citation46 Optimise digital human resource and patient information management systems^Citation60
Implement funding models and financial levers which support EI	Shift service design principles from outputs to outcomes and demonstrate alignment between investment and desired results^Citation41 Implement activity-based funding model^Citation36 Include efficiency savings in budget structure^Citation50 Use price setting and grants to optimise resource allocation^Citation62 Include financial incentives and/or penalties in pricing models^Citation51,Citation69,Citation70
Provide data, analytics and digital enablement for EI	Provide data insights to identify and measure opportunities^Citation40,Citation59 Supporting decision-making and reduce variability in care through provision of data and analytics^Citation48,Citation52,Citation56 Develop a centralised analytics framework^Citation38 Use digital approaches to workforce optimisation, waste reduction, expenditure visibility and communication^Citation59
Develop capability and skills for EI	Develop clinical, people management, leadership and financial management skills^Citation45 Implement improvement frameworks for identification, sharing and implementation of best practice and associated work cultures^Citation55,Citation64,Citation69 Provide a framework for health economics evaluation^Citation72 Provide a framework for knowledge sharing^Citation31 Establish workforce capability framework outlining efficiency-specific qualities and proficiency across roles and seniority^Citation37 Provide a centralised framework to support decision-making for new health technologies^Citation43
Generate and apply evaluation and evidence for EI approaches	Consider existing projects to inform and scale future work^Citation41 Identify optimisation-enabling factors including digital, workforce, funding, infrastructure and partnership in future planning^Citation55 Invest in evaluation and evidence-building for cost-effectiveness of public health strategies^Citation58 Provide a framework for evaluating projects and programs to determine outcomes gained for resources invested^Citation29 Provide external recommendations for high-level EI opportunities including assessment models, effective governance and knowledge sharing^Citation69,Citation71

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NSW Agency for Clinical Innovation. Knowledge Management: An ACI Approach. Sydney (AU): ACI; 2013.

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ACT Health. ACT Health Directorate Strategic Plan 2020–25. Canberra (AU): ACT Health; 2019.

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ACT Health. ACT Health Governance Framework 2018–2023. Canberra (AU): ACT Health; 2018.

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Australian Department of Health. Addendum to National Health Reform Agreement 2020–2025. Canberra (AU): ADH; 2020.

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Independent Hospital Pricing Authority. Pricing Framework for Australian Public Hospital Services 2022–23. Sydney (AU): IHPA; 2021.

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NSW Health Clinical Excellence Commission. Healthcare Safety and Quality Capabilities. Sydney (AU): CEC; 2021.

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NSW Health. NSW Health Analytics Framework. Sydney (AU): NSW Health; 2016.

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NSW Health. eHealth Strategy for NSW Health 2016–2026. Sydney (AU): eHealth NSW; 2016.

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Healthshare. HealthShare Strategic Plan 2020-2024. Sydney (AU): Healthshare; 2020.

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NSW Health. NSW Health Commissioning for Better Value Strategy 2021-24. Sydney (AU): NSW Health; 2021.

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NSW Health. Financial Requirements and Conditions of Subsidy (Government Grants). Sydney (AU): NSW Health; 2021.

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NSW Health. NSW Framework for New Health Technologies and Specialised Services. Sydney (AU): NSW Health; 2018.

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NSW Health. Future Health: Guiding the Next Decade of Care in NSW 2022-2032. Sydney (AU): NSW Health; 2022.

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NSW Health. Health Professionals Workforce Plan 2012-2022 Revised 2015. Sydney (AU): NSW Health; 2015.

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NSW Health. Resource Efficiency Strategy 2016 to 2023. Sydney (AU): NSW Health; 2016.

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NSW Health. Corporate Governance & Accountability Compendium- Section 7 Finance. Sydney (AU): NSW Health; 2019.

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Northern Territory Health. NT Health Workforce Strategy 2019 - 2022. Darwin (AU): NT Health; 2019.

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Northern Territory Health. Strategic Plan 2018-2022. Darwin (AU): NT Health; 2018.

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Northern Territory Health. Service Plan 2021-22: NT Regional Health Services Plan. Darwin (AU): NT Health; 2021.

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Northern Territory Health. Service Plan 2021-2022: Performance Framework. Darwin (AU): NT Health; 2021.

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Queensland Health. Optimising the Allied Health Workforce for Best Care and Best Value. Brisbane (AU): QLD Health; 2019.

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Queensland Health. Destination 2030: Great Care for Central Queenslanders. Brisbane (AU): QLD Health; 2017.

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Queensland Health. Queensland Health Performance and Accountability Framework 2020-2021. Brisbane (AU): QLD Health; 2020.

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South Australia Health. SA Health Performance Framework. Adelaide (AU): SA Health; 2021.

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South Australia Health. State Public Health Plan 2019-2024. Adelaide (AU): SA Health; 2018.

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Tasmanian Department of Health. Digital Health Transformation – Improving Patient Outcomes. Hobart (AU): Tas Health; 2022.

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Tasmanian Department of Health. Health Workforce. Hobart (AU): Tas Health; 2021.

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Tasmanian Department of Health. Tasmanian Health Service 2020-21 Service Plan (May 2021 Amendment). Hobart (AU): Tas Health; 2021.

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Victoria Health and Human Services. Decision Making Framework for Funding Policy. Melbourne (AU): Vic HHS; 2016.

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Victoria Health and Human Services. Policy and Funding Guidelines 2020–21 Policy Guide. Melbourne (AU): Vic HHS; 2020.

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Victoria Health and Human Services. CAPABILITY for INNOVATION and IMPROVEMENT STRATEGY 2017–20. Melbourne (AU): Vic HHS; 2017.

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Victoria Health and Human Services. Victorian Health Services Performance Monitoring Framework 2019–20. Melbourne (AU): Vic HHS; 2019.

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Western Australia Department of Health. Clinical Services Framework 2020 Addendum. Perth (AU): WA DoH; 2021.

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Western Australia Department of Health. Key Performance Indicators (KPIs) and Targets. Perth (AU): WA DoH; 2021.

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Australian Health Research Alliance. National Framework for Health Systems Improvement and Sustainability. Sydney (AU): AHRA; 2018.

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Grattan Institute. Incentives for Efficiency. Carlton (AU): GI; 2021.

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Australian Government Productivity Commission. Efficiency in Health. Canberra (AU): AGPC; 2015.

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