1. Partnering to CHOOSE WISELY A Housestaff-Leadership Collaboration to Promote High-Value Care
Presented by:
Wade Iams, MD
Josh M. Heck, MD

2. Choosing Wisely®
Initiative of the American Board of Internal Medicine Foundation
“Aims to promote conversations between physicians 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
Choosing wisely solicited top 5 lists from specialty societies:
medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

3. Create A Powerful Coalition
Donald Brady
Associate Dean for
Graduate Medical Education
Jack Starmer
Chief Quality Informatics Officer
Josh M. Heck
Chief Radiology Resident
Wade Iams
Internal Medicine Resident
Meghan Kapp, MD
Pathology Resident
Jenna Walters, MD
Anesthesiology Resident
Michael Vella, MD
General Surgery Resident
Cody Penrod, MD
Pediatrics Resident
Bonnie Miller
Sr. Associate Dean for
Health Sciences Education
William Fulkerson
Associate Hospital Director
Jeff Creasy
Neuroradiology Attending
Kevin Flemmons
Hospitalist
David Leverenz, MD
Internal Medicine Resident
In January
Dean Brady / Miller – present High Value care at GMEC and ask if anyone is interested
Find out there was a similar effort at one point – Starmer
Join forces – Heck/Brady/Starmer/ Iams/Miller
Recruit other interested people
As progessed have had more people approach with interest
We recognized the value this campaign for our institution began looking for ways to implement the Choosing Wisely initiatives throughout the medical center. Prior experience had demonstrated that there was significant potential for improvement. An initial effort aimed at eliminating unnecessary preoperative chest radiographs revealed that chest radiographs were obtained on 30% of our patients despite only 8% meeting the appropriate criteria.
This experience also reinforced that a multi-disciplinary approach was going to be crucial for our effort to be successful. Analysis of the Choosing Wisely recommendations had made it clear that these initiatives often cut across a large number of specialties (Chart 1). Therefore we created a steering committee comprised of representatives from a broad range of roles and clinical specialties including: Associate Deans of the Medical School, the Chief Quality Informatics Officer for the hospital, attending clinicians and house staff representatives from internal medicine, radiology, general surgery, anesthesiology, pediatrics and pathology

4. The task was daunting
Currently over 52 societies have created lists resulting in over 250 recommendations
We needed to figure out a way to approach this and get it into a manageable format
All selected top 10 that were important to us in general and to our specialty
Got a top ten list and looked for ones that would
What is our mission? What is our purpose? How do we align with the hospital’s goals? And one seemed to pop out

5. This recommendation was widely recognized as an opportunity for improvement, across almost all specialities
Wouldn’t take too much convincing – people self identified it as a problem

6. Anticipate Barriers Mention milestones Develop marketing
The “bottom up” effort was aimed at educating house staff and equipping them supporting evidence based facts to review with their attendings during teaching rounds.

7. What’s Your Default? Create a Vision DAILY LABS NECESSARY LABS
And we needed something to remind others too
Launched a marketing campaign – what is your default. Do you just get labs every morning without thinking about it.
Do you hit the Common OB QAM 0500 or do you only get labs that you need?
NECESSARY
LABS
CHOOSE WISELY.

8. Create a Vision What it came down to was this… My alarm clock
I get up at 4:30 and hit snooze maybe…
But my patients wake up to this….

9. Stay Focused Justice Potter Stewart Who is this?
Why is he on my slide?
But when working on this. There is always a temptation to take control and “tell people what to do”
An important part of our message has been “you already know it when you see it”
You know what good medicine is. When you are doing something you don’t need or out of fear.
Justice Potter Stewart
(Supreme Court Justice 1958 – 1981)

10. Encourage Change
But what we can do is let you know how you are doing. And how your peers our doing
We can celebrate your successes along side of you
And encourage you when there are continued opportunities for improvement.
We can look at things holding you back and remove those barriers or investigate the legitimacy of those fears
We can start conversations

11. Celebrate Small Victories
But what we can do is let you know how you are doing. And how your peers our doing
We can celebrate your successes along side of you
And encourage you when there are continued opportunities for improvement.
We can look at things holding you back and remove those barriers or investigate the legitimacy of those fears
We can start conversations

12. Sustaining Change Develop a plan for “non-responders”
Support from leadership is crucial
Temporarily transition to “top-down” approach
Standing agenda item
Standardize and automate
Need top down approach and support
A lot remains to be done.

13. Housestaff want to be a catalyst for change
Lessons
Housestaff want to be a catalyst for change
Leadership support is paramount to success
Attending buy-in is critical
Marketing and competition
Alleviate fears, remove barriers, stay focused on what is important to them
Will you support us?