Establishing and using a Steering Group Hi I am Nick Rogers- Anaesthetist at Wellington Hospital and Member of the Choosing wisely steering group at the hospital. I am going to talk about setting up and Using a Choosing wisely steering group. I will talk about what we have done that I think work well and also touch on some of the things that haven’t gone so well or that I think we could do better. Dr Nicolas Rogers Anaesthestist CCDHB Choosing Wisely

Why a Steering Group? Start by asking Why use SG? Lots of people with ideas. CMO/GM may want to encourage Choosing wisely Small projects OK. More Wide reaching projects difficult complex nature of bringing about change- especially in a larger DHB. Gathering data can be difficult, knowing the processes involved and the people that need to be involved is a challenge. And often good ideas remain ideas and don’t get progressed.

Why a Steering Group? A steering group aims to solve a lot of these problems. Our steering group was set up to help facilitate clinical change using the choosing wisely principles in our hospital. Ours was set up with the full involvement of CMO, General manager, Ops managers and service leaders, Allies health and nursing. interact with all the different groups in the hospital taking their ideas and supporting them to make the change. provision of data and IT support, peer support to review current practice, help with developing new processes actively involved in navigating the often difficult and complex path to bringing about change.

Who should be on the steering group? Membership of the steering group is important 2014. CMO Geoff Robinson with the support of the General Manager. a small group of interested people and then grew the membership from there We also have a broad membership that includes multiple SMOs, RMOs, Senior nursing and Allied health representatives, Operations managers, Must have some members that have been in senior leadership positions so they know how the hospital runs and how to get things done. This is probably especially important for the chair. important to have a mix- with a good number of people with enthusiasm and new ideas. We have our current chair James Anne Aitcheson is the change management advisor. She was involved in setting up the group initially and is central in making everything work. She has a huge amount of institutional knowledge and experience of how hospitals work and has dedicated time to devote to the running of the steering group. She organizes our meetings, sets the agendas, and takes and distributes the minutes. She is involved in the creation of our various sub groups and working groups. Her knowledge of which people need to be involved and which processes need to be followed mean that things happen.

Practical running of a steering group Anne‘s role is like the conductor in an orchestra I think without having such a dedicated role we would not have been able to make the progress we have. We meet every two weeks Answer directly to GM and CMO few larger projects at the top of our agenda that we devote time to at the start of our meetings. These may have working groups that report back to the steering group. most members have smaller ongoing projects too. They can then report back to the steering group with their progress and next steps. This allows discussion amongst the group and advice. Small- momentum and sense of achievement Our projects have come about in a number of different ways Some of what we have done is based on work elsewhere such as Labs and Radiology, Looked at other choosing wisely ideas/NICE guidelines to make sure we were following them locally Some projects come about as a result audit findings or from variance in budgets, We have identified many things within our own organization. Often services that are struggling due to poor use of local resources i.e services that are struggling to meet demand have come to us for help them work out where they are not choosing wisely with their use of resources. For example we help support them to audit their clinical processes to and then give peep support to review the literature to assess their current practice, we may start a working group to study the issue. When though this process better ways of doing things are found we support them through the processes involved implementing them.

The end of the beginning! Dr Nicolas Rogers Wellington Hospital Nick.rogers@ccdhb.org.nz Twitter @nicolasrogers After 4 years we are doing pretty well- working out how to go about things It feels a bit like we are at the end of the beginning- We still have a long long way to go but it does feel like we are getting somewhere! I think a steering group is a sensible way to go about implementing choosing wisely and I can think of few negatives of using one like we have. If anyone has any questions about how we run things or want to share idea about what we have been doing please get in touch Thank you Some issues we have had is finding replacements for members when they have had to leave the group. It often is just not possible to match someone who is free at the same time that we meet. Another issue seems to be Losing inertia over XMAS/ new years The future… James E meets with other DHBs Ways to improve Choosing wisely meeting with project presentations etc Log of successes Other DHBs can easily replicate then Attempt to nationalise successes