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‘The way we do things around here’ – A story of becoming a Choosing Wisely Champion Health Service

The Prince Charles Hospital in Chermside, Queensland is one of the newest Choosing Wisely Champion Health Services. Jessica Toleman, Senior Director of Clinical Operations tells the story of embedding Choosing Wisely into the organisation during COVID-19, making Choosing Wisely ‘the way we do things around here’.

At The Prince Charles Hospital, we are continually working to improve the healthcare services we provide so we can better support the health of our community. Our Executive Director gave her full support for Choosing Wisely, saying “The partnership with Choosing Wisely reflects our desire to provide high quality, high value care and enables us to challenge the way healthcare is delivered. If we can reduce the time, energy and resources used in delivering low value care, we can redirect our efforts into new and innovative high value care.”

We have made Choosing Wisely a focus to improve the way we work. Joining Choosing Wisely during the COVID-19 pandemic has encouraged clinicians to increase engagement across the hospital and think about how we can best use available resources.

The Choosing Wisely program we are implementing is made up of two complementary components:

  1. Empowering consumers to ask if the test or procedure they are about to get is really necessary and whether it adds value to their outcome and experience.
  2. Empowering our clinical staff to ask the same questions about their own practice – if this test or procedure does not add value to the patient outcome, should we do it?

We are creating a culture around Choosing Wisely, embedding its principles in our job descriptions, orientation, policy documents, Performance Framework and hospital-wide approaches.

We kicked off Choosing Wisely with a hospital-wide launch to raise awareness of Choosing Wisely across our health service. The fact that it was a virtual event meant that it had broader reach, engaging staff who would not have been able to attend in person. We had broad participation in staff surveys that have helped identify gaps in the way we work and potential future Choosing Wisely projects. We hope to do the same with our consumer survey in late March.

We are hosting ‘Grand Rounds’ – another virtual event where we showcase the results of our findings and upcoming Choosing Wisely projects, and celebrate what we are doing well. Our current program in the Emergency Department which uses a traffic-light system to avoid unnecessary coagulation studies is an example of a successful project we will be celebrating that lives Choosing Wisely principles. We have encouraged Choosing Wisely project proposals in all specialities across the hospital and have a long list of suggested projects with goals ranging from deprescribing inappropriate medications, to reducing unnecessary blood gases, to reducing fasting times for patients in the fasting clock project.

The tireless work by our extremely motivated clinical champions has been supported by the Choosing Wisely steering committee and project leads. The implementation toolkit from Choosing Wisely Australia has provided a framework to get started and template documents to support the rollout of Choosing Wisely initiatives.

All of this was done during COVID-19, so we have had to be flexible, with a lot of the work taking place virtually. Video conferencing has had positives and negatives. It has led to a broader reach, with staff forums being accessed by people who would not have been able to attend in person. The virtual environment is, however, less suited to one-on-one conversations and can result in a reduced ‘personal touch’. Our advice is ‘use virtual wisely’ – use it for broad information sharing. For one-on-one, make it as personal as possible – keep the video on!

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