Canterbury DHB focus

Canterbury DHB focusing on embedding Choosing Wisely approach

Canterbury District Health Board was an early supporter of the Choosing Wisely campaign, something service improvement lead Carol Limber puts down to the DHB’s history of embracing similar principles.

“The Canterbury health system has long had a focus on things like patient choice and bringing primary and secondary care together. Because of this it wasn’t a leap to bring a Choosing Wisely lens to some of the projects we were doing.”

These projects have been numerous and varied, promoting the Choosing Wisely approach to patients and clinicians. They have included the use of radiology for pre-operative testing, the investigation of pulmonary embolism, and the investigation of sub-arachnoid haemorrhage.

“Last year we ran an awareness campaign in outpatients, encouraging patients to ask questions,” she says.

“We also had a grand round on Choosing Wisely and national guidelines. This took the form of a debate that challenged the sometimes automatic fallback to using national or international guidelines that don’t always incorporate a Choosing Wisely approach.”

She says the DHB is now moving away from individual Choosing Wisely projects and focusing on embedding the approach, particularly through health pathways.

“Every time someone looks at a relevant health pathway, Choosing Wisely recommendations pop up.

“A lot of it is also having conversations with individual clinicians who are trying something different; talking to them about building Choosing Wisely principles into their business as usual. It is now less about getting the message out and more about embedding it.

“I believe that where this works well is when you get senior medical officers on the ward round support junior doctors to question whether a test is really necessary.”

She says the downside of focusing less on specific projects and more on embedding change is that it’s hard to measure. “And if you do measure change, it’s difficult to show whether it is the result of a Choosing Wisely approach or because of the various other initiatives underway.”

She says the DHB’s future focus is on continuing to embed the Choosing Wisely approach.

“These are the principles we have been working with for some years. It’s about what we do, when we do it and where we do it.”

She says thought is also turning to areas in health care where we need to do more rather than do less. “Ophthalmology is a good example, we needed to do more follow up of glaucoma. This had slipped because of focuses on other areas so we had to redress the balance.”

Some of the services the DHB provides show a broad application of Choosing Wisely principles.

“For example, the delivery of ambulatory therapies and infusions within community settings rather than hospital, and reviewing our use of hospital out-patient follow up.

“We are also funding winter checks for people who are more at risk of illness because of chronic conditions. They see their general practice team for an extended visit – they will get a medicine review, discuss advance care planning, discuss their acute care plan, and talk about whether they need anything put in place over winter.

“While these are not, strictly speaking a Choosing Wisely approach, the principles are the same.”

July 2019