New clinical guidance paired with statewide policy provides clinicians with evidence-based criteria to make decisions about a range of surgical procedures.
Value-based surgery helps ensure patients receive safe, effective and timely surgical care in NSW public hospitals. Performing the right procedure, for the right reasons, at the right time helps patients avoid unnecessary surgeries, reduces unwarranted clinical variation and relieves pressure on the hospital system.
“Data indicates that some procedures are highly effective for certain patient groups, but offer far less benefit for others,” says Professor Neil Merrett, Director of Surgery at South Western Sydney Local Health District and ACI Surgical Care Network Chair. “With value-based care, we’re identifying the groups of patients who will benefit most from the surgery being offered to them.”
New resources that support value-based surgery
In 2022, the ACI Surgical Care Network published the Value-Based Surgery Clinical Practice Guide. The guide provides evidence-based advice for clinicians aiming to perform more clinically appropriate procedures. It offers specific guidance for a range of procedures, including knee arthroscopy; tonsillectomy; myringotomy without insertion of grommets; hysterectomy; asymptomatic hernia repair; lumbar spinal fusion for back pain alone; and colonoscopy.
In December 2025, the ACI published guidance for a second tranche of procedures on the updated value-based surgery web pages, including:
- hysterectomy, specifically for heavy menstrual bleeding
- spinal fusion for isolated low back pain
- open reduction of clavicle and scapula fractures.
Danielle Wheelwright, Surgical Care Network Manager, led the development of these new resources at the ACI with a subject matter expert working group to identify which procedures to focus on. “The decision was based on evidence and potential impact – where targeted patient selection would reduce unwarranted clinical variation and make the biggest difference for patients and the health system," she says. "We want this initiative to support clinicians to consistently deliver best-practice care."
The new guidance includes clearer patient eligibility criteria for each procedure, and takes into account procedure volumes and clinical variation across the state.
Formalising value-based surgery through policy
The NSW Health Planned Surgical Access Policy now formalises the value-based surgery eligibility criteria across NSW public hospitals. This is an important step in managing public hospital waiting lists, and ensuring timely, equitable access to elective surgery.
Sarah-Jane Waller, Associate Director of Surgical Services for the NSW Ministry of Health, says the inclusion of the eligibility criteria provides a timely opportunity for clinicians to review their practices to ensure their patients are receiving the most appropriate care.
Close partnership between policy and clinical networks elevates policy – grounding it in real-world care and giving it a stronger platform for impact.
Professor Merrett stresses that these protocols are not designed to replace clinical decision-making or critical thinking. “It's important that clinicians know we're not trying to stop them treating their patients. We're trying to ensure that they’re treating them in the best way possible, with the most up-to-date options for patients in these particular categories,” he says. “This may involve the patients or their records being reviewed at a multidisciplinary clinic in specific instances to ensure that there is peer agreement on the correct treatment pathway, as already happens in the treatment of many other conditions, such as cancer.”
Adoption of the value-based surgery eligibility criteria is an important step in ensuring equitable access to surgery in NSW public hospitals. As these new criteria are used across the state, the working group will continue to identify procedures and develop guidance where a value-based approach would be useful.
Explore the latest value-based surgery web resource.