Less is more: choosing health care wisely

Clinicians across Australian health services are reducing low-value and unnecessary interventions — such as pathology tests, antibiotics and imaging — as part of the Choosing Wisely Australia initiative.

Choosing Wisely — a global campaign in more than 20 countries — encourages better conversations between health professionals and consumers about appropriate tests, treatments and procedures. It was launched in Australia by NPS MedicineWise in 2015 and today 44 colleges, societies and associations are members, producing lists of evidence-based healthcare practices to question.

A flexible approach to implementation

Australia’s Choosing Wisely Champion Health Services network is facilitated by NPS MedicineWise and has teams of health professionals and consumers working together across departments, and entire organisations in more than 30 health services, on local projects addressing low-value health care.

Participating organisations commit to six governing principles:

1. Health profession-led
2. Clear emphasis on improving quality of care and on harm prevention
3. Multidisciplinary
4. Patient-focused communication between health professionals and consumers
5. Evidence-based
6. Transparency in processes and supporting evidence

However, the clinician-led approach of Choosing Wisely encourages individual sites to determine the problems they want to address, from one project in a single department to embedding Choosing Wisely in performance frameworks for the whole organisation.

Scale-up in Victorian hospitals

Examples of local innovation were demonstrated in a recent 12-month Choosing Wisely Scaling Collaboration in Victoria, supported by Safer Care Victoria, Austin Health and NPS MedicineWise.

Safer Care Victoria Innovation Projects Manager Camilla Radia-George said in 2016–17 the Better Care Victoria Innovation Fund supported Austin Health and Eastern Health to deliver projects to reduce low-value care.

“We were impressed with their outcomes, the engagement with clinicians at all levels and their plans to embed and sustain the change,” she said.

“As a result, we partnered with these Choosing Wisely Champions and NPS MedicineWise to scale this to other Victorian health services keen to tackle ‘waste’ in their organisations.

“We supported 11 health services using a collaborative model that involved design workshops and sessions on identifying areas of low-value care, communication, implementation, clinician and consumer engagement, sustainability and evaluation.

“These workshops allowed services to come together and share challenges, approaches and other resources.

“We are currently wrapping up the evaluation and thinking about key learnings to design our next Choosing Wisely initiative.”

Safer Care Victoria Innovation Projects Manager Camilla Radia-George.

Patients at the centre

Choosing Wisely seeks to empower Australians to ask questions about their health care, and encourages health professionals to drive these important conversations, to ensure patients and carers can be proactive participants.

“One of the ways Choosing Wisely Australia worked with the Victorian collaboration was promoting access to consumer resources, including its ‘5 questions to ask your doctor’ available in multiple languages,” Radia-George said.

“Many sites included these resources as part of their multifaceted behaviour change.

“A number of individual sites also evaluated the impact of their projects by surveying consumers about their understanding of Choosing Wisely as well as their beliefs and attitudes towards low-value care.”

Health service resources

Along with Choosing Wisely recommendations, resources are available to help health services implement Choosing Wisely initiatives. They include the print and digital consumer resource ‘5 questions to ask your doctor or healthcare provider’.

A step-by-step ‘Implementation Toolkit’ developed by the Victorian Scaling Collaboration is also available. It provides best-practice advice on data collection, design, change management and evaluation, with real-world case studies from the Victorian collaboration showcasing practical ideas for identifying projects and engaging staff and consumers.

For example, a key consideration for health services is deciding who needs to be involved. Melbourne’s St Vincent’s Hospital introduced monthly ‘executive huddles’ to the Choosing Wisely project, where anyone with an interest could discuss ideas, barriers and progress. This avoided a top-down approach.

With its electronic medical records, the Royal Children’s Hospital accessed large datasets to determine areas for improvement. It reviewed performance against five recommendations from the Royal Australasian College of Physicians Paediatrics & Child Health Division. They chose to reduce the over-ordering of chest X-rays for children with suspected bronchiolitis and a corresponding over-ordering of oral antibiotics.

Be part of the change

Choosing Wisely is changing a health professional and consumer mindset that ‘more is always better’. Identifying and addressing low-value and unnecessary healthcare is a key part of creating change to benefit patients and the whole health system.

For more information about how your health service can get involved, visit choosingwisely.org.au.

*Dr Robyn Lindner is Client Relations Manager at NPS MedicineWise.

Top image: A Choosing Wisely workshop in Victoria.