Clinical commissioning was introduced in South Australia in 2012 to support implementation of the South Australian Health Care Plan and to achieve the desired transformation and efficiency gains required for a sustainable health system. This paper describes how the South Australian Commissioning Model was established and the process of developing the necessary culture, governance arrangements and performance management structures. Commissioning has played a key role in improving appropriateness and quality of clinical practice, resulting in reduced hospital inpatient growth and average length of stay. Despite early successes, there remain many challenges that need to be faced before value can be demonstrated consistently across the whole system.
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