Choosing Wisely at Waikato DHB

Reinvigorating Choosing Wisely at Waikato DHB

Veronique Gibbons is team leader, clinical effectiveness in Waikato DHB’s quality and patient safety team. The DHB is very supportive of having a Choosing Wisely approach, but momentum has stalled a little since the programme was introduced in 2016. Veronique has been charged with reinvigorating things – a challenge she is very happy to take on.

“Choosing Wisely was brought out with a bang in 2016, and the Choosing Wisely concept gathered great support from laboratory, radiology and pharmacy; in places that often saw the tail end of overuse.

“For example, people would sometimes order two units of bloods and the blood bank was seeing unnecessary wastage. They put in place changes that meant you could only order one unit at a time, except in certain circumstances. This has reduced wastage. For lab tests we are trying to move people away from ticking all the boxes, to only selecting what they need for their diagnosis.

“But beyond a few instances like these where gatekeeping limits choice, a Choosing Wisely approach wasn’t really being taken. My job is to spread it more widely among consumers and clinicians.”

Veronique says not everyone in the DHB gets Choosing Wisely – “it may be something that ‘somebody else’ does but we all need to play our part.”

She says the programme is all about encouraging people to think critically. ”As John Bonning, our ED physician and Choosing Wisely champion says, it’s about rationalising not rationing.

Veronique went to the IHI (Institute for Healthcare Improvement) conference in September and says Choosing Wisely featured quite a lot.
“Someone gave an example of junior doctors ordering tests because they were concerned the consultant would ask why something wasn’t tested for – so they would test for everything. But in fact, when they had the consultants in the room with the junior doctors to talk this through, the consultants said what they wanted was rationale for why the tests were or were not done, not that they wanted all the tests to have been done.”

Veronique Gibbons

Veronique’s team is working to put someone in a Choosing Wisely role. Their job would be to work with clinicians and also to get consumers on board with the Choosing Wisely message.

“One of the challenges is getting clinicians to change the way they do things. I’m trying to work up the organisational support that sits behind them and endorses a Choosing Wisely approach.”

She also has some Choosing Wisely projects in mind. “Two areas we may focus on initially include fluid balance charting and urine testing. A key thing for me is that any change is measurable.”

She says Waikato DHB does things really well, but it’s easy to get stuck in the day-to-day routine.

“I see so many opportunities to further improve the quality of the care we provide.”

 

March 2019