Decisions of Value

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An integral part of any NHS decision maker’s work is to balance the priorities of quality improvement and financial sustainability – in other words, to deliver value. This balancing act has become increasingly challenging as the demands on the NHS change and grow, with more expected within an ever tighter budget.

Decisions of Value project

Decisions of Value is a project, commissioned by the Department of Health and led by the Academy of Medical Royal Colleges and the NHS Confederation. It has spent six months studying what influences how decisions are made, focusing on decisions that impact on quality and finance. 

It brings together a large amount of research to show how factors such as relationships, behaviours and environment influence decisions that impact on the value delivered and how this extends beyond Whitehall to the front line.

A better understanding of this balancing act, how considerations about quality and finance can complement rather than compete with each other, will help the NHS prepare and change to meet the needs of the populations health.  

We gathered information for the project in three ways:

1.  National engagement: we surveyed over 200 NHS staff nationally. View the infographic to see the key findings.

2.  Evidence review: we commissioned the Health Services Management Centre at Birmingham University to carry out a literature review on the decision making process. View the literature review.

3.  Local and expert engagement: we carried out a series of in-depth interviews and convened a series of expert group meetings. View the summary of our findings.

Our findings

The project's findings emphasise the importance of the cultural, rather than structural, changes needed to move towards delivering better value and look at how they rely on having the right relationships, behaviours and environments in place. It presents insights into how people interact in the NHS and the crucial factors affecting how they operate within a particular context. 

In many cases, what we find indicates a ‘back to basics’ approach that involves a fundamental understanding of how humans interact and operate. As such, it doesn't define good decisions, but rather gives an insight into the principles of good decision-making.

The project's findings point to six factors needed to support decisions of value and notes the progress being made in these areas. Find out more by visiting the web sections on relationships, patients and behaviours and information, environment and peer support.

A culture of stewardship

Pre-eminent healthcare value expert, Prof Sir Muir Gray has distilled his insights into a new briefing: A culture of stewardship.  It highlights the importance of establishing a culture of stewardship and challenges NHS leaders to take responsibility for the value and sustainability of their services.

The publication also describes how the NHS can change the way it uses public resources over the next five years. Find out more about our work on value-based healthcare.

Further information

If you have any questions about the project, please email

Communication graphic

Information, environment and peer support

Find out about the findings of the Decision of Value project, with regard to information, environment and peer support

silouet people

Relationships, patients and behaviours

Find out about the findings of the Decisions of Value project, with regards to relationships, patients and behaviours

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