Choosing Wisely Supported through System Level Clinical Quality Governance Dr Sharon Kletchko MD FRCPC FRACP Quality Risk Clinical Governance Director Lakes DHB

Clinical Quality Governance (CQG)Principles Managed through networking & feedback at all levels Clearly defined roles, responsibilities & accountabilities Ensures clarity & consistency of standards Uses evidence-based methodologies Promotes a culture of openness & transparency Enables good performance management of individuals & teams Ensures a culture of continuous improvement – energetic & enthusiastic willingness to work across the system Supports autonomy of department level decision-making Supports ‘whole Organisation) ‘quality’, ‘innovation’ & ‘change’ Enables the focus on patient / whanau ‘connectedness’ from bedside to board-room

A Networked/Linked approach Patients Whanau Subcommittees Choosing Wisely, IPC, Resuscitation, PAC, Child & Youth, HiAG, Medical Education, System-Level CQI, M&M, audit Professional Forums Clinical Teams

LDHB CQG & Choosing Wisely Importance of broad governance and extensive follow-up essential to success CQG provides an ‘Organisational decision-making structure’ using ‘iterative feed-back loops’ and ‘team of teams’ approaches The CQGE provides: the over-arching leadership to drive the process of dissemination, cross-fertilisation, and system response Resources to disseminate and to implement Background to ‘Choosing Wisely’ and FRACP ‘EVOLVE’ programmes The Choosing Wisely campaign aims to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidence Not duplicative of other tests or procedures already received Free from harm Truly necessary In response to this challenge, national organisations representing medical specialists asked their providers to “choose wisely” by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed. The resulting lists of “Things Providers and Patients Should Question” are intended to spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. EVOLVE [Evaluating Evidence, Enhancing Efficiencies] is a physician-led initiative to ensure the highest quality patient care through the identification and reduction of low-value practices and interventions Low-value care is use of an intervention where evidence suggests: it confers no or very little benefit on patients, or, risk of harm exceeds likely benefit, or, the added costs of the intervention do not provide proportional added benefits.