Public Hospital Services > Te Whatu Ora – Health New Zealand Counties Manukau >

Library Database & Resource Directory | Counties Manukau | Te Whatu Ora

Public Service, Other

Innovation and Improvement Clearinghouse

*The Innovation and Improvement Clearinghouse is a Ko Awatea resource supporting health system innovation and improvement.


Selected documents and resources
Selected learning opportunities
Staying current
Innovation and improvement at Counties Manukau Health & Ko Awatea
Innovation hubs (NZ)
Innovation hubs (International)

Whats's New

Health Improvement and Innovation Digest

The goal of the Health Improvement and Innovation Digest is to improve the health and wellbeing of New Zealanders by sharing the latest research that can help drive innovation and quality improvement. 



Research Review [NZ]
Research Review is an independent publishing company that harnesses the expertise of New Zealand's leading specialists to select and advise on the most important medical research and the local implications. We condense what's important and bring it to subscribers on a regular basis as a four page summary with a specialist opinion and a web link to the full study. The Reviews keep medical professionals up to date in over 40 interest areas.

Health Systems Evidence database
Maintained by McMaster University this database is a comprehensive, free access point for evidence to support policy makers, stakeholders and researchers interested in how to strengthen or reform health systems or in how to get cost-effective programs, services and drugs to those who need them.

Implementation Science
Implementation Science is an open access, peer-reviewed online journal that aims to publish research relevant to the scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organisational or policy contexts.
Healthcare Transformation
Peer-reviewed, open access journalzine, delivers foremost research in re-imagining healthcare delivery, education, technology, innovation, and discovery.
Health system quality dashboard
Health & Quality Safety Commission (NZ)
Counties Manukau Health Library Innovation and Improvement Clearinghouse Super Search
A customised google super search engine to retrieve the latest news, developments and publications from more than 70 leading innovation hubs worldwide.
Research HINTS
When searching databases such as PubMed / Medline / CINAHL add "quality improvement" as a subject heading ( MeSH) to your search.
When looking for Randomised Controlled Trials and/or Systematic Reviews in an area identified for improvement do your subject search on PubMed and then use the 'Article type' filter to only include RCTs and systematic reviews in your results list.
Example :
SEARCH: AND "quality improvement"[MeSH Major Topic] AND (Randomized Controlled Trial[ptyp] OR systematic[sb])

Search Strategy Used to Create the Systematic Reviews Subset on PubMed

This strategy is intended to retrieve citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, guidelines, and citations to articles from journals specializing in review studies of value to clinicians. This filter can be used in a search as systematic [sb].

     Example: exercise hypertension AND systematic [sb]

This filter is also available on the Filters sidebar under "Article types." It is also available on the Clinical Queries screen.  Use the  'Clinical Queries'  search template in PubMed to identify Systematic Reviews on your topic of interest.
When reviewing abstracts identified in your search results on PubMed use the 'Similar articles' and 'Cited by' features to read more widely on the topic.

Selected documents and resources

What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System (2023)

Paper examining the views on quality improvement managers in New Zealand on the competencies and qualities required ‘to achieve day-to-day and long-term quality improvement objectives.’ Based on interviews with 56 quality improvement managers from across New Zealand, the study identified two groups ‘traditional and clinical quality improvement managers’ with the traditional group being ‘those with formal quality improvement education’ while the clinical group ‘was represented by clinical staff—physicians and nurses—who received on-the-job training.’ The authors report three major themes emerged from the interviews: quality improvement expertise, leadership competencies and interpersonal competencies. The ‘traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers’.


Cambridge Elements: Improving Quality and Safety in Healthcare.  THIS Institute, Cambridge

The THIS Institute (The Healthcare Improvement Studies Institute) at the University of Cambridge has developed this series of open access publications. The series seeks to offer ‘a comprehensive and authoritative set of overviews of the different improvement approaches available, exploring the thinking behind them, examining evidence for each approach, and identifying areas of debate’.

Elements that have been published include:

  • Workplace Conditions
  • Simulation as an Improvement Technique
  • Reducing Overuse
  • Implementation Science
  • Making Culture Change Happen
  • Co-Producing and Co-Designing
  • Collaboration-Based Approaches
  • The Positive Deviance Approach.


Building an organisational culture of continuous improvement: Learning from the evaluation of the NHS partnership with Virginia Mason Institute | The Health Foundation (2022)

The evaluation of the NHS partnership with Virginia Mason Institute, which examined how five NHS trusts in England attempted to build a culture of continuous improvement, provides important lessons about how to plan and implement an organisation-wide approach to improvement. This long read outlines some of the key learning from the evaluation and offers recommendations for national policymakers and local systems leaders. 

Measures Library (HQSC)

Health sectors rely on data to improve quality. Our Measures Library provides technical documents and summaries, management and case documents, plus links to other resources like the Atlas of Healthcare Variation.

Beyond improvement skills: what do clinicians, managers, patients and others need to do to make improvement happen? (BMJ Quality and Safety; 2022)

In this issue of the journal, Wright et al offer an in-depth examination of the implementation of six improvement projects in three English hospitals to elucidate the work that matters most to those directly involved


Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies (BMJ Quality and safetyl 2022)

Our case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed.

Using social media as a tool to facilitate consumer engagement in service design and quality improvement: A guide for hospitals, service providers and consumers ( La Trobe University, 2022)

‘Using social media as a tool to facilitate consumer engagement in service design and quality improvement: A guide for hospitals, service providers and consumers’ is a guide designed to help hospitals, providers and consumers include social media-based methods into their suite of consumer engagement activities.

Researchers from the Centre for Health Communication and Participation at La Trobe University, along with an advisory committee of consumers and service providers, developed this guide. It draws from findings of a review of international literature, and new research exploring the use of social media as a consumer engagement tool in Australia.

What enabled health service innovation during the pandemic? Crisis, staff, system or management?

Deeble Institute

This Perspectives brief from the Australian Healthcare and Hospitals Association‘s Deeble Institute examines some of the changes that happened in Queensland during the VOVID-19 pandemic. The authors argue that the pandemic saw rapid shifts in the way health care is being delivered, but their focus on the factors that enabled innovation to occur. They examine the key enablers of innovative allied health models of care and practice changes within Queensland’s publicly funded health services during the pandemic preparedness phase. Based on interviews with 28 health professionals conducted by the Allied Health Professions’ Office of Queensland (AHPOQ) the brief identifies three key innovation enablers: adaptive management style, devolved authority structures and trust in staff capability.


Quality improvement made simple. What everyone should know about health care quality improvement
The Health Foundation (2021)

The Health Foundation in the UK has produced an updated third edition of their Quality improvement made simple guide. According to the Health Foundation, improving quality is about making health care safe, effective, patient-centred, timely, efficient and equitable. It’s about giving the people closest to problems affecting care quality the time, permission, skills and resources they need to solve them. Quality improvement involves the use of a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement within a health care setting. This guide offers an explanation of some popular approaches used to improve quality, including where they have come from, their underlying principles and their efficacy and applicability within the healthcare arena. It also describes the factors that can help to ensure the successful use of these approaches and methods to improve the quality of care processes, pathways and services.


New Zealand Māori quality improvement in health care: lessons from an ideal type
International Journal for Quality in Health Care, Volume 16, Issue 5, October 2004, Pages 417–422
There is no single best approach to quality improvement. Quality improvement has been adapted from its predominantly Japanese origins to form distinct, hybrid systems embedded in national cultures. These systems have seldom been studied despite their potential internationally to inform the local management of health care organizations. This article suggests six lessons from an ‘ideal type’ of one such system, New Zealand Māori quality improvement in health care. Mapped against ‘mainstream’ concepts of quality improvement, the lessons are to: emulate the character of leaders in health care; encourage ‘cultural governance’; operate the health care organization as a ‘family’; move forward with eyes on the past; foster spiritual health; and respect everything for itself. These lessons support a global struggle by indigenous peoples to have their national cultures reflected in programmes to improve their health care, and have potential relevance to mainstream services. By increasing cultural competence, responsiveness to indigenous health needs, and awareness of insights from another culture, the lessons reveal opportunities to improve quality by incorporating aspects of a Māori ideal type.


A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches
Canadian Patient Safety Institute (2020)
When it comes to patient safety, a substantial body of evidence exists to demonstrate interventions (leading practices and processes) that lead to improved patient outcomes for numerous healthcare conditions. Despite available evidence, practice changes are not implemented consistently and effectively to support organizations and teams to address patient safety challenges.

This resource has been designed to support teams across all healthcare sectors in using a Knowledge Translation and Quality Improvement integrated approach to change that will impact patient safety outcomes. This Guide for Patient Safety Improvement is intended to accompany current best available evidence change ideas, and tools and resources for your specific project. It includes ideal practice changes “the what” and strategies “the how” that creates the evidence-based intervention. Adaptations are expected and important considerations for implementation will be provided in this guide.

What influences improvement processes in healthcare? :A rapid evidence review
RAND Corporation (2020)
The Healthcare Improvement Studies (THIS) Institute commissioned RAND Europe to conduct a rapid evidence review of the academic and grey literature, to draw out initial learning about what influences quality improvement processes in healthcare, and to inform potential themes to explore in future research.

Key Findings

We identified and reviewed 38 academic and 16 grey literature publications covering diverse improvement approaches. Some examples include Six Sigma, Lean, Business Process Reengineering, Plan-Do-Study-Act, clinical audits and feedback, quality improvement collaboratives and peer-learning communities, training and education interventions, and patient engagement and feedback-related interventions.

Key influences on improvement processes in healthcare
Based on the reviewed literature, six key factors influence the implementation of improvement efforts:

Relationships and interactions that support an improvement culture
Skills and competencies
Use of data
Patient and public involvement, engagement and participation
Working as an interconnected system of individuals and organisations, influenced by internal and external contexts

This review also attempted to go beyond identifying these high-level influences by explaining what specific aspects of the influencing factors are important for quality improvement. The report provides a detailed analysis of influencing factors across the six categories outlined above, as well as summary tables for each.


Implementation Science Resource Directory
Melbourne Academic Centre for Health (MACH)
With an increasing focus by health services, government and funding bodies on implementing evidence into practice and policy, Melbourne Academic Centre for Health (MACH) has developed a free online directory of implementation science tools and resources for students, clinicians and researchers to make it easier to find resources that support efforts to improve routine practice and care.  

The new MACH Implementation Science Resource Directory conveniently brings together diverse digital tools and resources into a central location to support health implementation efforts by beginners and experts.

Creating a culture of excellence: how healthcare leaders can build and sustain continuous improvement (KPMG: 2019)
At a time when healthcare faces growing challenges globally, KPMG International set out to learn how leading healthcare organizations around the world are successfully building and sustaining a culture of continuous improvement. As part of this report we have produced a short series of video interviews with a number of international contributors, who share their perspectives and learning.

Quality improvement (BMJ; Health Foundation, 2018 -)
The BMJ and the Health Foundation have launched a joint series of papers exploring how to improve the delivery of healthcare. The series aims to discuss the evidence for systematic quality improvement, provide knowledge and support to clinicians, and ultimately to help improve care for patients.

How do we ensure that innovation in health service delivery and organization is implemented, sustained and spread? (WHO: 2018)
This policy brief (i) reviews the main frameworks and factors that have been identified as supportive for the successful introduction of innovation in service organization and delivery and (ii) illustrates these factors using selected examples of service innovations in European countries.

Improving the quality of health services: tools and resources. Turning recommendations into practice (WHO, 2018)The World Health Organization (WHO) has released this document that compiles together a range of WHO resources with the aim of supporting the implementation of quality improvement approaches to make health services more effective, safe and people-centred. The compilation lists the main quality improvement tools and resources currently used within WHO’s Department of Service Delivery and Safety. However, as is noted, this compendium is not an exhaustive list of quality improvement interventions.

From PES to PDSA: A guide to using the patient experience survey portal for quality improvement (HQSC, 2018)From PES to PDSA outlines how to use the patient experience reporting portal for quality improvement.  Written collaboratively with the Commission's quality improvement team, this document breaks down Plan, Do, Study, Act cycles into well-defined steps so you can streamline quality improvement activities within your primary health organisation or general practice.

Building Capacity and Capability for Improvement [NHS]
This is a guide for NHS organisations seeking to begin or do more to build improvement capacity and capability in their organisations. It should be used in conjunction with Developing People – Improving Care an evidence-based, adaptive national framework published in December 2016 to guide action on improvement skill and capability building, leadership development and talent management for people in NHS-funded roles in England.

10 IHI Innovations to Improve Health and Health Care  (IHI, 2017)
About 10 years ago, IHI established a Research and Development team and a systematic process of 90-day innovation cycles to tackle some of the vexing issues in health care. A new publication, 10 IHI Innovations to Improve Health and Health Care, curates some key ideas that have emerged from this systematic approach, and reshaped how and what IHI has committed itself to over the years — including the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, among others. 

Making the case for quality improvement: lessons for NHS boards and leaders ( Kings Fund / Health Foundation, 2017)
This briefing makes the case for quality improvement to be at the heart of local plans for redesigning services. The briefing does this by drawing on existing literature and examples from within the NHS of where quality has been improved and describing how this was done. It describes the potential benefits from investing in quality improvement – including for patients, staff and the financial sustainability of the system. 

Embedding quality improvement skills: guides to build improvement capacity and capability (NHS Improvement, 2017)
These guides are for organisations seeking to begin or build on their improvement capacity and capability.

Leading large scale change: A practical guide to leading large scale change through complex health and social care environments (NHS, 2017)

Quality Improvement Essentials Toolkit (IHI, 2017)
IHI’s QI Essentials Toolkit includes the tools and templates you need to launch and manage a successful improvement project. Each of the ten tools in the toolkit includes a short description, instructions, an example, and a blank template.

BMJ Quality Improvement Series (BMJ, 2018)
The BMJ has, in conjunction with The Health Foundation, launched a joint series of paper on how to improve the quality of healthcare delivery.

What we know about designing an effective improvement intervention (but too often fail to put into practice) [BMJ Quality & Safety, 2017)       

Open innovation in health: A guide to transforming healthcare through collaboration [Nesta, 2017] 

Caring for Quality in Health: Lessons Learnt from 15 Reviews of Health Care Quality [OECD, 2017]

Building the foundations for improvement: how five UK trusts built quality improvement capability at scale within their organisations [Health Foundation]

Exploring the links between quality improvement strategies and organisational outcomes in four New Zealand district health boards [NZ MoH, 2016]

Performance Improvement Framework: Core Guide 3: Getting to great: Lead reviewer insights from the Performance Improvement Framework [NZ State Services Commission] 

Evaluation: what to consider. Commonly asked questions about how to approach quality improvement in health care [Health Foundation]

Communications in health care improvement - a tool kit [Health Foundation]

Using communications approaches to spread improvement [Health Foundation]

Overcoming challenges to improving quality [Health Foundation, 2012]

Findings from a survey of healthcare delivery innovation centers [Commonwealth Fund]

Improving quality and achieving equity: a guide for hospital leaders [Disparities Solutions Centre]

Roadmap to Reduce Disparities: a six-step framework for healthcare organisations to improve minority health and foster equity [Finding Answers: Disparities Research for Change]

The Art of Making Change - theories, approaches, tools and techniques for creating meaningful change [Leadership Centre, 2015]

A guide to quality improvement tools [HQIP, 2015]

Quality improvement made simple: what everyone should know about healthcare quality improvement [Health Foundation, 2016]

RCEM Quality Improvement Guide: a practical guide for clinicians undertaking quality improvement in Emergency Departments [RCEM, 2020]

Evidence scan: Quality improvement training for healthcare professionals [Health Foundation, 2016]

Crossing the quality chasm:a new health system for the 21st century [NAP. 2001]
see also 10 New Rules to accelerate healthcare redesign

Improving care delivery through Lean: implementation case studies [AHRQ, 2014]

The CAHPS Improvement Guide [AHRQ]

Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture [AHRQ]
This document contains references to Web sites that provide practical resources hospitals can use to implement changes to improve patient safety culture and patient safety.

Standards for Quality Improvement Reporting Excellence [SQUIRE]

Designing and growing innovation: a case study [State Services Commission study of Canterbury District Health Board]

Experience Based Co-Design Toolkit [Kings Fund]

Health Service Co-Design Toolkit [Waitemata DHB, NZ]

Creative Approaches to Problem Solving: Methods Toolkit - [Q Improvement]
A fabulous free toolkit of 25 methods for creative problem solving. There are many of Helen Bevan's favourite tools here, all well explained & organised by objectives

Co-design: shared perspectives on authentic co-design: putting consumers and carers at the center of mental health reform (Co-design Initiative, 2016)

The quest for integrated health and social care: a case study in Canterbury, New Zealand [The Kings Fund]

Stewarding regional health transformation: a guide for changemakers [ReThink Health, 2015]

Performance Improvement Framework [NZ State Services Commission]

Who's who in healthcare sustainability? [Counties Manukau Health]

 see also


Case Studies, Posters and Examples of Innovative Practice:
NHS Improving QualityNHS Scotland


see also


Value-Based Health Care


Value-based health care
Harvard Business Review

Based on the research of Professor Michael Porter, Value-Based Health Care is a framework for restructuring health care systems around the globe with the overarching goal of value for patients.

Value-based health care is one of the most important topics in health care transformation today. Value-based approaches to organizing care are widely touted as critical to improving the health outcomes of patients worldwide and controlling runaway health care costs. Value-based health care's central tenant is that the overarching principle in redesigning health care delivery systems must be value for patients. We define value as the outcomes that matter to patients and the costs to achieve those outcomes.


There are six major elements that are necessary in a truly value-based system:
  1. Organize Care Around Medical Conditions
    Care delivery is organized around patients' medical conditions or segments of the population.

  2. Measure Outcomes & Cost for Every Patient
    Outcomes and cost are measured for every patient.
  3. Aligning Reimbursement with Value
    Reimbursement models that reward both better outcomes and efficiency of care, such as bundled payments.

  4. Systems Integration
    Regional delivery of care organized around matching the correct provider, treatment, and setting.

  5. Geography of Care
    National centers of excellence providing care for exceedingly complex patients.

  6. Information Technology
    An information technology system designed to support the major elements of the agenda.

Defining Value-based Healthcare in the NHS
Centre for Evidence-base Medicine (2019)

"Value-based healthcare is the equitable, sustainable and transparent use of the available resources to achieve better outcomes and experiences for every person."

‘Value’ is gaining prominence in healthcare systems facing increased demand for services with limited resources. However, value-based healthcare has not yet been embraced as part of the everyday language and business of the NHS in the way that evidence-based healthcare has.

The absence of an agreed definition of ‘value-based healthcare’ in the NHS, the lack of skills required to deliver value-based healthcare and a clear understanding of the barriers to effective development and implementation inhibits the health system in addressing problems such as overdiagnosis, too much medicine, poor allocation of resources and the introduction of inadequately evidenced technologies

This report sets out a route to defining value-based healthcare in the NHS, an assessment of the barriers to its development, and an understanding of what skills and training would support implementation. A stakeholder workshop informs the report with patients and leaders across the NHS and value sector.


Approaches to better value: improving quality and cost
The KingsFund, 2018

  • The NHS is increasingly focusing on how it can improve the value of its Services, to deliver the highest quality health outcomes for patients at the lowest possible cost.
  • This report shares learning and insight from three NHS hospital trusts that have developed organisation-wide strategies for value improvement. It draws on interviews, roundtables and site visits with senior leaders in the NHS who are committed to developing better value services.
  • Our report suggests a wide variety of approaches are being taken to improve value in the NHS. These include top-down programmes that focus on a wide range of clinical services from their inception, to value improvement strategies that are more organically grown from a few individual services until they cover a wider breath of hospital-based care.
  • While there are differences in how organisations are approaching value improvement, there are also several common conditions for success. These include fidelity to a clearly defined strategy that brings the various strands of value improvement work together; recognition that value improvement is a long-term commitment that will require considerable staff time and resources; and a new leadership approach that requires continuous engagement with frontline clinicians and managers.

Value-Based Healthcare Toolkit
Canadian Foundation for Healthcare Improvement: 2020

Value-Based Healthcare (VBHC) is becoming a leading approach to improving patient and health system outcomes around the world. It is one-way of organizing healthcare to transform health outcomes.

VBHC is about linking the dollars spent to outcomes that matter to patients, rather than to the volumes of services, processes or products that may or may not achieve those outcomes.

VBHC aims to deliver services that are high value, scale back or drop those that do not, and/or re-balance the mix of services to improve the ratio of outcomes to overall costs. The goal is better outcomes at the same or lower total cost.

The purpose of this toolkit is to provide information and guidance to those who are interested in learning about value-based healthcare (VBHC); those who are thinking about implementing it; and those who are ready to assess and improve their current VBHC initiatives.

Implementing Value-Based Health Care in Europe: Handbook for Pioneers
EIT Health, 2020

VBHC provides a methodology for measurable health and care outcomes that make the biggest difference to patients, while driving cost efficiencies within health services.

The EIT Health handbook and framework explores insights from pioneers in the field and defines the key steps critical to implementing VBHC in health services. Directed by Professor Gregory Katz, Chair of Innovation & Value in Health at the University of Paris School of Medicine, it aims to help health care providers fully realise the opportunity presented by VBHC and drive forward a medical culture shift in Europe.


Value-based healthcare - what is it and can it work in New Zealand?
HiNZ, 2018

Value-based healthcare drives accountability for outcomes and creates incentives for improving patient outcomes at lower costs. What would it take to move to this focus on quality, outcome and performance in our healthcare funding?

What is the future for value-based healthcare?
Deloitte, 2020

Across Europe there have there are distinct patterns of VBHC adoption with key therapy areas like oncology and rare diseases leading the way. In early adopter countries. VBHC is underpinned by system and policy leadership, supported by access to relevant datasets. However, there are a number of common reasons why VBHC has not yet been adopted at scale. We consider each of these reasons and identify potential catalysts to help organisations realise the true potential of VBHC.

Value-Based Healthcare in Practice: A Systematic Review
Journal of Healthcare Management , 2021

Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.

The Strategy That Will Fix Health Care 
Michael Porter and Thomas Lee, Harvard Business Review 2013

Based on the 2006 book by Teisberg and Porter ‘Redefining Health Care’ this HBR paper describes how the health system needs to make value the overarching goal of the health system, shifting the focus from volume to value or improving the outcomes that matter to patients relative to the cost of achieving those outcomes. The strategic agenda is based on six interdependent components: organizing around patients’ medical condition, measuring costs and outcomes for every patient, developing bundled prices for the full care cycle, integrating care across separate facilities, expanding geographic reach and building an enabling IT platform.

Value in Healthcare Laying the Foundation for Health System Transformation 2017
World Economic Forum in collaboration with The Boston Consulting Group

Value in Healthcare has been an ongoing project led by the World Economic Forum and more recently the Global coalition for Value in Healthcare has been established. This paper from 2017 described the foundation for health system transformation including the foundational principles (health outcomes that matter to patients and the costs across the full cycle of care, the identification of clearly defined population segments, the development of segment-specific interventions) and key enablers (informatics; benchmarking, research and tools; payments that help to improve patient value; new roles and organizational models) and public policy that shape the healthcare sector’s legal and regulatory environment. There are a range of other papers in the series available on the Global Coalition’s website here.

Value-based healthcare: A global assessment, 2016
The Economist Intelligence Unit

The Economist Intelligence Unit has published a number of case studies and policy papers and also conducted this study on value-based healthcare alignment across 25 countries - a qualitative study across four domains of enabling context, policies and institution in healthcare; measuring outcomes and costs; integrated and patient-focused care and outcome-based payment approach.

Value Based Health Care: Setting the scene for Australia
Deeble Institute issues brief, no 31, 2019

Established by the Australian Healthcare and Hospitals Association in 2019, the Australian Centre for Value-Based Health Care is pursing the creation of a system where health care is funded and delivered with a prime focus on outcomes achieved at an affordable cost for patients and the health system.

Victorian Dental Health Services
*video presentation

Dental Health Services Victorian won the 2019 European Value Based Health Care Europe primary care award. This is a link to a short presentation in the Australian Health Journal and provides insight into the challenges of implementing VBHC and also some of their early successes with decreases in failure to attend rates, dentists practicing at the top of their scope, increased preventative interventions.

The Diabeter

Established in 2006, the Dutch clinic network Diabeter has been a pioneer in value-based diabetes care, focusing on e-health solutions, delivering individualized, comprehensive care and supporting self care management. This website contains information about Diabeter and a white paper by BCG that describes how they have implemented the six components of the Porter value agenda.

How Dutch Hospitals Make Value-Based Health Care Work
A Boston Consulting Group case study

This describes how Santeon, a Dutch network of hospitals, began implementing VVBHC in 2015 among five patient groups with breast cancer, prostate cancer, lung cancer, stroke and hip arthritis. It describes the infrastructure, governance and approach to measurement and suggests key lessons for other hospitals (eg develop common understanding of value, start small and be pragmatic, build a safe learning environment, have medical professionals take the lead, implement with the patient). Breast Cancer is the most advanced group and they reduced reoperations due to positive surgical margins by 17%, postop complications after lumpectomy by 27%.

A case study by All. Can, an international multi-stakeholder initiative working to improve the efficiency of cancer care

The Martini-Klink in Germany is the biggest specialist prostate cancer centre worldwide (website here). This case study describes how they systematically measure the quality of care using outcomes that are most relevant to patients. Examples include rates of incontinence and erectile dysfunction following treatment. These data are shared with the healthcare professionals at the clinic to continually revise and improve care.

The European Commission report on defining value.

The European Commission produced a report on effective ways of investing in health and adopted an opinion on defining value in “value-based health care”. They proposed to define VBHC as a comprehensive concept built on four value-pillars: appropriate care to achieve patients’ personal goals (personal value), achievement of best possible outcomes with available resources (technical value), equitable resource distribution across all patient groups (allocative value) and contribution of healthcare to social participation and connectedness (societal value).

A Queensland Health video describing the importance of VBHC

This is a Metro North HHS video that reinforces the importance of optimal care pathways and guidelines and collecting data on the outcomes that matter to patients through the story of Peter. He is a hypothetical character with prostate cancer who received prostate surgery (at a cost of $21,000 and with a reduction in the quality of his life due to unwanted outcomes of incontinence and erectile dysfunction) rather than the recommended approach of regular monitoring for men with low risk prostate cancer.



Selected learning opportunities


Ko Awatea
Exciting programme of courses, workshops and learning events hosted by Ko Awatea 

Ko Awatea LEARN
LEARN is an interprofessional educational community that gives healthcare professionals the skills they need to become change agents in health care improvement.  We’re talking about skills like quality improvement, patient safety, communication, leadership, and patient-centered care. Leaders are looking for these skills, and patients expect providers to have them.

Improving Together
Improving Together is a national learning programme that focusses on quality improvement for people delivering education, social services and health services. You can find out how improvement methodologies accelerate learning and innovation, and how it can be applied to improve the quality of social service delivery in New Zealand.

Improvement Knowledge and Skills Guide [ HSE, Ireland]
This guide will help to support the ongoing learning and professional development of all staff both clinical and non-clinical by providing a list of improvement knowledge and skills which can help to educate, train and guide staff on how to deliver improvement in the health service.

LEAN Thinking
LEAN Thinking is a methodology that will help you improve quality of care, increase efficiency of processes, and identify and eliminate waste. LEAN Thinking evolved in the manufacturing industry but is now routinely applied in the health sector. This course introduces the LEAN methodology and a number of associated tools to implement the methodology in your work environment.

Lifehack Resource Library
Guidelines and workshops to support design thinking to support better health outcomes. Lifehack is a space where people can come together to develop new approaches, projects and ventures, with young people at the centre of the process. We bridge backgrounds, skill sets and place, and empower young people and communities to redefine their own version of success. In short, Lifehack is the R&D ground for Youth Wellbeing interventions.

The School for Change Agents
Develop the skills to make a difference and create change in your organisation on this course targeted at health and care staff.

IHI Open School Video Library (videos)
The growing library of freely available IHI Open School videos is one way to learn from health care leaders and experts from around the world as they share bite-sized pearls of knowledge and advice. In the newly reorganized IHI Open School Video Library, browse by topics such as improvement capability; patient safety; person- and family-centered care; Triple Aim for populations; quality, cost, and value; and leadership.

Health Improvement Scotland QI Global Webex series
Hour long webinars from global leaders in health care transformation and innovation.

Risky Business
Exceptional talks sharing ideas on risk, culture, human performance, teams and leaders.

TedMed talks (videos)
TEDMED is the independently owned and operated health and medicine edition of the TED conference, dedicated to “ideas worth spreading.” TED Talks have been viewed online over two billion times around the world.
"TEDMED convenes and curates extraordinary people and ideas from all disciplines both inside and outside of medicine in pursuit of unexpected connections that accelerate innovation in health and medicine".

Stanford Centre for Professional Development: Innovation and Entrepreneurship Series
View online, without charge, webinars, seminars, and lectures presented by Stanford faculty, industry experts, and senior researchers.
see also Institute of Design at Stanford
A range of free resources, and learning experiences to develop design thinking. Includes a virtual "90 minute crash course in design thinking".

Leadership in Healthcare: a Clearinghouse of Resources for Health Professionals
Curated by the Counties Manukau health Library


Staying current



Grey Matter
Research Review [NZ]
Health Improvement and Innovation Digest -
NZ Ministry of Health Library roundup of literature, research, tools and case studies
Health Roundtable Roundup
On the Radar [ACSQHC)
Health Quality & Safety Commission e-update


Follow (via twitter)

Counties Manukau Health [NZ]
Counties Manukau Health Library [NZ]
Health Affairs
Health Foundation
Health Quality and Safety Commission [NZ]
Health Research Council New Zealand [NZ]
Health Roundtable
Healthcare Improvement Scotland
Institute for Healthcare Improvement (IHI)
Ministry of Health (NZ)
National Institute for Health Innovation [NZ]
Nuffield Trust
Nursing Review New Zealand [NZ]
NZ Doctor [NZ]
Quality Watch [UK]
Research Review NZ [NZ]
TeamHQi [NZ]
The King's Fund


Innovation and improvement at Counties Manukau Health & Ko Awatea


Counties Manukau Health Performance and Planning
- Health Targets
- Serious Adverse Events
- Planning Documents
- Health Status Documents

Quality Improvement at Counties Manukau Health: A case study evaluation


Ko Awatea Publications

Health Transformation series

Creating Systems (Healthcare Transformation Book 1)
by David Galler , Jonathon Gray , Muir Gray [Kindle edition]
September 2015 LINK

Population Medicine (Healthcare Transformation Book 2)
by Jonathon Gray, Karina McHardy, Muir Gray  [Kindle edition]
June 2015 LINK

Creating Culture (Healthcare Transformation Book 3)
by Geraint Martin, Jonathon Gray, Mataroria Lyndon, Lynne Maher, Muir Gray [Kindle edition]
September 2015 LINK

Knowledge Management (Healthcare Transformation Book 4)
by Muir Gray , Jonathon Gray, Eli Rotenberg, Clare Nelson, Peter Murgatroyd & Lynne Armstrong [Kindle edition]
April 2017 LINK

Ko Awatea White Papers


Final Reports of Major Campaigns and Reports

Target CLAB Zero

20,000 days

Beyond 20,000 days

Handle the Jandal

Manaaki Hauora – Supporting Wellness


Evaluations and Joint Publications with HQSC



Ko Awatea Publications (articles, presentations etcetera) 

Health system and service level improvement













The Medicine Stories Project

The Medicine Stories Project collection (PDF, 5.6 MB)


 Expert Views 


*external website


New Zealand

Ko Awatea [NZ]
Counties Manukau Health's centre for innovation and improvement

The National Institute of Health Innovation [NZ]
At NIHI we measure our success by our contribution to improving people’s health in New Zealand and around the globe.  We discover, develop, test and deliver innovative approaches to today’s most pressing health problems.  Our work is focused on preventing disease, improving people’s health, reducing health inequities and enabling the delivery of more effective and equitable healthcare.  We provide independent scientific evidence that supports individuals, communities, clinicians and policymakers.  Supported by The University of Auckland and Auckland UniServices Limited infrastructures, we are experts in providing researchers with complex project management, IT, data management and analytics support, delivery of commercial health projects and commercialisation/deployment of health initiatives.

Health Improvement and Innovation Resource Centre (HIIRC) [NZ]
* ceased operation 1 July 2015.  Archive only.
Improvement and innovation is occurring throughout New Zealand’s health care system. The HIIRC supported this by providing: an extensive knowledge library of literature directories of individuals and organisations access to improvement projects, tools and initiatives the latest news, events and innovations.  Whilst the site is no longer being updated the Ministry of Health library continues to curate and disseminate the Health Improvement and Innovation Resource Centre Digest .

** Archives of resources from the HIIRC site including project initaitves and case studies can be viewed as follows:
Hospital productivity
Māori health innovation
Primary care
Quality improvement
Improved access to elective surgery
More health and diabetes checks
Better help for smokers to quit
Increased immunisation
Shorter stays in ED
Faster cancer treatment

Health Innovation Hub [NZ]
Confidentially and alongside the clinicians, we provide industry with access to clinicians and their new ideas. We also provide innovative clinicians with advice on product design and health innovation funding options.

Health Quality and Safety Commission [NZ]
The Health Quality & Safety Commission works with health professionals, patients and consumers across health and disability services to improve the quality and safety of care. A range of resources including: Open Book - reports to alert providers to the key findings of adverse event reviews. The reports emphasise the changes implemented to stop the event happening again.

See also Resources for providers starting quality improvement projects [primary care]

Health Research Council of New Zealand [NZ]
The HRC supports research that has the potential to improve health outcomes and delivery of healthcare, and to produce economic gain for New Zealand.

Health Roundtable [NZ / Aus.]
We are a non-profit membership organisation of health services across Australia and New Zealand. We exist to:
Provide opportunities for health executives to learn how to achieve Best Practice in their organisations

Collect, analyse and publish information comparing organisations and identifying ways to improve operational practices

Promote interstate and international collaboration and networking amongst health organisation executives

Members are provided with a wide range of documents and presentations that identify innovations in health care practice, as well as comparative information and meeting notes. Any staff member from a member health service can access these reports by registering for access with their health service email address.

89 health service organisations across Australia and New Zealand are currently members of The Health Roundtable. Many health service members have multiple facilities. A total of 155 facilities currently provide data for comparative analysis.

Telehealth Resource Centre [NZ]
Brings together information about the various regulations and guidelines that apply to telehealth as well as explaining services the centre provides like free on-site visits and education workshops. Includes case studies and resources to support implementation.

Innovation hubs (international)

International Society for Quality in Health Care (ISQua)
ISQua's mission is to inspire, promote and support continuous improvement in the safety and quality of health care worldwide.

WHO Patient Safety portal
"Adverse events may result from problems in practice, products, procedures or systems. Patient safety improvements demand a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care"

World Innovation Summit for Health (WISH)
A global healthcare community dedicated to capturing and disseminating the best evidence-based ideas in healthcare, providing global solutions that will save both lives and much needed resources.




Australian Centre for Health Innovation [Aus.]
The Australian Centre for Health Innovation (CHI) connects diverse health, policy and industry communities to more effectively address the changing needs of healthcare and improve patient experience.

Australian Commission on Quality and Safety in HealthCare [Aus.]
The Australian Commission on Safety and Quality in Health Care (the Commission) was created by Health Ministers in 2006, and funded by all governments on a cost sharing basis, to lead and coordinate health care safety and quality improvements in Australia.

Australian Institute of Health Innovation [Aus.]
We are leading researchers investigating many aspects of health care. We are a major national resource for many people whose work is intrinsic to strengthening health systems, organisations and services.

ACI: NSW Agency for Clinical Innovation - see also the ACI Innovation Exchange [Aus.]
The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and promote better healthcare for NSW.

Clinical Excellence Commission [Aus.]
The Clinical Excellence Commission (CEC) is responsible for leading safety and quality improvement in the NSW public health system. It was established in 2004 to promote and support improved clinical care, safety and quality across NSW.

Australasian Association for Quality in Health Care [Aus.]
It is a member-driven, not-for-profit organisation served by a volunteer Council comprised of representatives from all Australian States and Territories and New Zealand.

Health Issues Centre [Aus.]
We support and inform consumers and the health sector to partner for health care improvements.


United Kingdom

Advancing Quality Alliance (AQuA)
Is a NHS health and care quality improvement organisation who are at the forefront of transforming the safety and quality of healthcare.

AHSN Atlas of Solutions in Healthcare
 he AHSN Atlas is an online resource that shares some of the very best examples from across the Academic Health Science Networks of how to spread high impact innovation across the health and care system.

Cochrane [UK]
We are a global independent network of researchers, professionals, patients, carers, and people interested in health.

Healthcare Improvement Scotland [UK]
We produce a range of resources from evidence based reports to best practice and improvement guides. All our resources are designed to support healthcare improvement.

Healthcare Quality improvement Partnership [UK]
The Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales.

The Health Foundation [UK]
The Health Foundation is an independent charity working to improve the quality of health care in the UK. We are here to support people working in health care practice and policy to make lasting improvements to health services. We carry out research and in-depth policy analysis, run improvement programmes to put ideas into practice in the NHS, support and develop leaders and share evidence to encourage wider change.
see also Improvement Research Institute [UK]

The Health Innovation Assessment Portal (HIAP-Scotland)
The Health Innovation Assessment Portal (HIAP-Scotland) to encourage prospective providers of new and/or innovative products and solutions to put them forward. This will allow NHSScotland to assess how the solution might support NHSScotland's strategic aims, and what the associated costs and benefits would be

Health Quality Improvement Partnership [UK]
The Healthcare Quality Improvement Partnership (HQIP) is an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices. We were established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality improvement.

Institute of Global Health innovation [UK - Imperial College London]
The Institute of Global Health Innovation (IGHI) works to design & diffuse high impact global healthcare innovations and to reduce health inequalities worldwide.

NHS Scotland, Quality Improvement Hub [UK]
Includes a section on quality and efficieny supporting the business case for safety.

The Nuffield Trust [UK]
The Nuffield Trust is an authoritative and independent source of evidence-based research and policy analysis for improving health care in the UK.

Quality Watch
A joint research programme of the Nuffield Trust and the Health Foundation monitoring how the quality of health and social care is changing over time. Highlights areas where improvement is possible.

Royal College of Emergency Medicine QI Resources [UK]
This page collates some of the most useful quality improvement resources for EDs.

Scottish Health Innovations Ltd. [UK]
Scottish Health Innovations Ltd works in partnership with NHSScotland to protect and develop new innovations that come from healthcare professionals.

Scottish Patient Safety Programme [UK]
National initiative that aims to improve the safety and reliability of healthcare and reduce harm, whenever care is delivered.

NHS Scotland Quality Improvement Hub [UK]
Contains resources, case studies, and networks for knowledge sharing.

The King's Fund [UK]
The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate.

THIS.Institute - The Healthcare Improvement Studies Institute [UK]
At THIS Institute we have an important goal: To strengthen the evidence-base for improving healthcare. Creating an evidence-base that supports replicable and scalable improvements to healthcare delivery and patient experiences.  Working in partnership with patients and NHS staff throughout the UK, we’re boosting research activity to provide more clarity on what works in improving healthcare, what doesn’t, and why. 

NHS Impact

NHS Impact is the new, single, shared NHS improvement approach. By creating the right conditions for continuous improvement and high performance, systems and organisations can respond to today's challenges, deliver better care for patients and give better outcomes for communities.  Includes a library of useful improvement resources.


United States

100 Million Healthier Lives [US]
100 Million Healthier Lives is an unprecedented collaboration of change agents who are fundamentally transforming the way we think and act to improve health, wellbeing and equity.
SCALE 1.0: Becoming Communities of Solutions SCALE 1.0: The first phase of Spreading Community Accelerators through Learning and Evaluation (SCALE 1.0, January 2015 – January 2017) supported 24 communities across 21 states in the U.S. to accelerate their community transformation journey toward a Culture of Health. These 24 communities, who worked on a variety of health, wellbeing, and equity topics, went on to support 43 additional communities in a program called Pathway to Pacesetters.
Key lessons learned in SCALE 1.0 can be found in the following 5 synthesis reports:
1.Overview of SCALE & a Community of Solutions
2.Foundations of a Community of Solutions
3.Engaging Community Residents with Lived Experience
4.Leading for Abundance: Approach to Generative Sustainability
5.Using Improvement Methods & Design Thinking to Guide Action

Agency for Healthcare Research & Quality (AHRQ) [US]
The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

see also AHRQ Innovations Exchange
The Innovations Exchange is expanding efforts to scale up and spread innovations by sponsoring three Learning Communities (LCs) focused on the following high-priority topic areas: “Advancing the Practice of Patient- and Family-Centered Care in Hospitals,” “Reducing Non-Urgent Emergency Services,” and “Promoting Medication Therapy Management for At-Risk Populations.”

Centre for Health Care Innovation [US: Penn Medicine]
The Penn Medicine Center for Health Care Innovation facilitates the rapid, disciplined development, testing and implementation of new strategies to reimagine health care delivery for dramatically better value and patient outcomes.

The Center for Health Organization Transformation
The Center for Health Organization Transformation, or CHOT, is an industry-university cooperative research center (I/UCRC) funded by the National Science Foundation and health organizations to conduct research supporting major management, clinical, and information technology innovations in healthcare.

Health Care Improvement Foundation [US]
The Health Care Improvement Foundation (HCIF), was founded to support a responsive, coordinated health care delivery system that fulfills the needs of patients and consumers, and achieves better health. Through large-scale collaboration, HCIF works with health systems, community based organizations, payors and a variety of other stakeholders to find solutions to complex healthcare challenges, which any one stakeholder could not achieve alone.

Healthy Mendocino Promising Practices Database
The Promising Practices database informs professionals and community members about documented approaches to improving community health and quality of life. The ultimate goal is to support the systematic adoption, implementation, and evaluation of successful programs, practices, and policy changes. The database provides carefully reviewed, documented, and ranked practices that range from good ideas to evidence-based practices.

Improvement Science Learning Centre [US]
Developed by Brandon Bennett this curated collection of resources includes eLearning Modules, Videos, and a range of tools, guides and frameworks.

Institute for Health Care Improvement [IHI] [US]
The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide.

Institute for Healthcare Optimization [US]
An independent not-for-profit 501(c)(3) research, education and service organization focused on bringing the science and practice of operations management to healthcare delivery.

The Commonwealth Fund [US]
The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

Mayo Clinic's Centre for Innovation [US]
Mayo Clinic's Center for Innovation fuses design principles with the scientific method to uncover human needs in the health care environment, which include empathy, creativity, systems thinking and a human-centered focus.

National Academies of Sciences, Engineering and Medicine: Health and Medicine Division [US]
HMD’s aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely.

National Patient Safety Foundation [US]
The National Patient Safety Foundation’s vision is to create a world where patients and those who care for them are free from harm. A central voice for patient safety since 1997, NPSF partners with patients and families, the health care community, and key stakeholders to advance patient safety and health care workforce safety and disseminate strategies to prevent harm.

Network for Regional Healthcare Improvement [US]
The Network for Regional Healthcare Improvement (NRHI) is a national organization representing over thirty member Regional Health Improvement Collaboratives (RHICs). These multi-stakeholder organizations are working in their regions and collaborating across regions to transform the healthcare delivery system and achieve the Triple Aim: improving the patient experience of care, including quality and satisfaction; improving the health of populations; and reducing the per-capita cost of healthcare.

ReThink Health [US]
We work with visionary leaders to transform health at the regional level – their neighborhoods, cities, counties, or states. Our hope is that by demonstrating regional success, we inspire transformation across the country.

The Beryl Institute
The Beryl Institute is the global community of practice and premier thought leader on improving the patient experience in healthcare. *Full text access to resources is limited to Beryl Institute members.

Choosing Wisely [US]
Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidenceNot duplicative of other tests or procedures already receivedFree from harmTruly necessary.

Planetree [US]
Planetree, Inc. is a mission based not-for-profit organization that partners with healthcare organizations around the world and across the care continuum to transform how care is delivered



Accreditation Canada: Leading Practices Database
Leading Practices Database is proud to serve as the new location for innovative practices from the former Health Council of Canada Health Innovation Portal. The Leading Practices Database fosters inter-organizational learning and harvesting of new ideas. It includes nearly 1,000 practices recognized as being particularly innovative and effective in improving quality.

Canadian Foundation for Healthcare Improvement
A not-for-profit organization funded by the Government of Canada, dedicated to accelerating healthcare improvement. CFHI plays a unique, pan-Canadian role in supporting healthcare delivery innovation. We help teams from different jurisdictions work together on common improvement priorities, providing opportunities to share and implement evidence-informed solutions across regions, provinces and territories.

Canadian Health Human Resources Network Innovations Portal
CHHRN partnered with the Health Council of Canada to initiate and populate a health human resources (HHR) innovations portal to showcase innovative approaches to health human resource issues.

Canadian Patient Safety Institute
The Canadian Patient Safety Institute (CPSI) is a not-for-profit organization that exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety.

The Change Foundation
An independent health policy think tank, The Change Foundation is changing the debate, practice and experience in Ontario health care, prompting system-wide, patient-centred improvements.



The Ubora Institute
Africa’s first institute dedicated to the use of improvement science to achieve the best in health and health care for the people of Africa. Launched in February 2016, Ubora, which means “excellence” in Swahili, has already lined up work in partnership with IHI to support health systems in Ghana and Liberia.


Last updated  4 September 2023

Document Downloads

This page was last updated at 9:50AM on October 9, 2023.