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System Level Measures Framework

Released on 13 May 2016, updated on 3 October 2017

The System Level Measures (SLMs) Framework aims to improve health outcomes for people by supporting DHBs to work in collaboration with health system partners (primary, community and hospital) using specific quality improvement measures. They provide a framework for continuous quality improvement and system integration.

System Level Measures are:

  • outcomes focussed
  • set nationally
  • require all parts of the health system to work together
  • focus on children, youth and vulnerable populations
  • connected to local clinically led quality improvement activities and contributory measures.

Contributory measures are:

  • chosen locally based on local needs, demographics and service configurations
  • used to measure local progress against quality improvement activities.

All measures are available under Health Quality Measures NZ

There are six System Level Measures:

  • Ambulatory Sensitive Hospitalisation (ASH) rates for 0–4 year olds (keeping children out of hospital)
  • acute hospital bed days per capita (using health resources effectively)
  • Patient experience of care (person-centred care) – this is made up of adult inpatient and primary care patient experience surveys. Further information about the survey, its development and administration, privacy assessment, results of inpatient experience surveys and information for patients, PHOs and practices can be found on the Health Quality & Safety Commission website. The first national report on results from the first year of pilots for the Primary care patient experience survey is also available from the Health Quality and Safety Commission website.
  • amenable mortality rates (prevention and early detection)
  • babies living in smoke-free homes (a healthy start)
  • Youth access to and utilisation of youth appropriate health services (youth are healthy, safe and supported). This SLM is made up of five domains with corresponding outcomes and national health indicators. Further information about this SLM, including the youth engagement story board can be found on the Ministry website.

System Level Measures recognises that good health outcomes require health system partners to work together. Therefore the district alliances are responsible for implementing SLMs in their districts.

District alliances are responsible for:

  • harnessing perspectives from all relevant parts of health system to identify shared vision and key objectives
  • applying alliancing principles (way of working)
  • using SLMs to drive system integration in their districts
  • allocating resources required for the development, implementation, monitoring and reporting of the SLMs
  • leading the development of the SLM improvement plan.

DHB is responsible for submitting the SLM improvement plan and the quarterly reports on behalf of their alliance.

This section includes detailed guidance to develop the Improvement Plans, the Guide to using the SLMs Framework, trend data for the SLMs and links to the Measures Library and communications to the sector.


System Level Measures Reporting Template

The purpose of this reporting template is to ensure consistency of reporting by DHBs and can be found at the following link:

Latest Communications

Link to key updates and communication to the sector on the System Level Measures framework.

Measures Library

The Library includes definitions for System Level and contributory measures and provides an online interactive space for the sector to collaborate. 


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