It is often quipped that a project can be fast, high quality and low cost, but not all three. In the case of the National Trauma Network (NTN), it has delivered improved patient outcomes in a relatively short time frame and crucially has demonstrated objective cost saving to the health system.

The triple aim embodied in quality improvement literature aims to produce better outcomes for the patient, for the population and for the system.[[1]] The nature of healthcare delivery in New Zealand means that it is often difficult to quantitate the financial benefits to the system for any quality improvement initiative. Trauma is an exception in that it is not only provided by the Accident Compensation Corporation (ACC) on a bulk-funded basis for prehospital and acute care but also on a fee-for-service basis for rehabilitation. In addition, the costs of lives lost are also borne by ACC, with its responsibility not only for immediate funeral costs but also for long-term support for dependent children.

The NTN was formed by the then Minister of Health in 2012 on the advice of the Quality Improvement Committee. Initially under the governance of the Ministry of Health, this role shifted across to ACC in 2015 when it was recognised that this organisation had the most to gain financially from better trauma care. Reduction in mortality rates and improved recovery of survivors would produce quantifiable financial gains for ACC. As a result, a series of business cases and subsequent contracts with the Trauma Network leadership have included specific Key Performance Indicators (KPIs) relating to financial targets and allowed the Network leadership the relative autonomy necessary to achieve these. The most recent business case covered the period July 2018 to June 2023.

The NTN was set KPIs in relation to case fatality rates, return on investment, average cost per claim and return to independence as well as a range of other patient-focussed KPIs.

Case fatality rates have continued to fall, and in the time period from 2018–2021 fell from 9% to 7.4%, which equates to approximately 35 lives saved each year.[[2]] A similar drop is also observed for Māori who experience major trauma. Individual claim costs have fallen by 4% leading to cumulative direct cost savings to ACC of $7.15 million. The cost benefit analysis of the trauma programme to ACC is for every dollar that is spent, two dollars are saved. As the benefit is cumulative, further savings are projected.

While the direct value of lives saved is modest, the recent valuation of the monetised benefits and costs published by Waka Kotahi was $4.1 million per death,[[3]] which would put the benefits of the 105 lives saved over this period as $430.5 million.

Disability-Adjusted Life Years is a metric widely used for measuring health loss. In a recently published study, the cost of health loss of hospitalised major trauma patients in New Zealand was estimated at $1.02 billion, and reduced per case by $19,170 over 3 years.[[4]] This saving applies to ACC and health agencies, and most importantly to individuals and New Zealand society as a direct result of improved trauma care.

These achievements have been delivered in the context of immense disruption to the programme of work. Aside from the recent impact of COVID-19, the governance structure of the NTN has been changed numerous times by the Ministry of Health and ACC and, presently, Te Whatu Ora – Health New Zealand.

Despite these challenges, the trauma programme has succeeded for many reasons. The committed teams in hospitals and regions have been and continue to be the backbone of delivering quality trauma care. The Health Quality & Safety Commission has planned and delivered effective trauma quality improvement programmes and the relative autonomy of the Network has allowed trauma leadership at national and regional levels to be nimble and focussed.

While it is not possible to monetise the savings delivered by other health networks it is likely that effective systems all generate improvements of care and save money. Variations in healthcare delivery is one of the factors associated with poorer outcomes—and efficient national systems reduce this. Te Whatu Ora – Health New Zealand offers the opportunity to deliver equitable care regardless of where the person was injured or any population characteristic. Using a financial model and KPIs has also allowed the NTN to quantitate expected and actual savings, justifying funding being specifically allocated to meet these expectations. This model of healthcare provision is not presently possible for other forms of publicly funded healthcare, but in the case of trauma allows clear demonstration of its benefits and justifies further investment.

New Zealand has an established contemporary trauma system and is now regarded as being among the best performers internationally. Not only do more people survive today than they did previously, but those who survive have lower levels of disability and this is reflected in the cost of delivering care. To continue to achieve the improvements in trauma care outcomes on the triple aim will require preservation of the key elements of the NTN that have been built up steadily over the last decade. The present health reorganisation is both a challenge and an opportunity—and hopefully both the effective structure of the NTN will be preserved and many new networks established that can use the evidence of patient, societal and financial benefits apparent from the NTN experience to shape their development.