Conferences Help Share Successes and Barriers to Move Choosing Wisely Forward

On April 30 and May 1, 2014, approximately 70 people representing national medical specialty societies, state medical societies, regional health collaboratives, consumer health engagement organizations and health systems gathered in Washington, DC, to share their progress in bringing the Choosing Wisely® campaign to their community.

The conference celebrated the successes of the 21 organizations supported by grants made possible by the Robert Wood Johnson Foundation that are working toward changing the current culture of overuse and waste in health care. The grantees reported that they have reached more than 170,000 physicians and more than 16 million consumers in just one year. This work includes:

• a smartphone app developed by the American Society of Echocardiography that provides decision support for physicians. It has been downloaded more than 2,500 times;
• a residency curriculum created by Better Health Greater Cleveland to help influence a new generation of doctors to think about overuse and stewardship of resources; and,
• Maine Quality Counts partnering with local practices and systems to disseminate Choosing Wisely information.

Such successes illustrate that change is happening at a community level. According to one Summit participant, “You do this at home and you’re excited about what you are doing. But talking with all of the other participants gave me the opportunity to share my excitement with others working toward the same goal.”

At the Summit, the grantees also shared barriers they encountered and discussed ways to move past them to improve their efforts. Participants shared a litany of issues they hear when trying to implement Choosing Wisely, such as the lack of time physicians have with patients or fear of lawsuits. Several attendees remarked that some physicians are afraid of saying no to patients because they want to be liked. Others stated that patients often don’t feel they have the power to question doctors and that a paternalistic culture in health care is still very real.

Participants advanced a number of ideas to overcome these barriers:

• Because Choosing Wisely fits well with many other important health initiatives, there is more uptake when it is aligned with these efforts.
• Messages personalized for individual physicians and patients reinforce communications from the national campaign.
• Taking time for physicians and patients to have these conversations is absolutely necessary.
• Culture change is hard. But one of the reasons Choosing Wisely has spread so quickly is that it has touched on real ideas that people care about and can get behind.

“The sessions encouraged a rapid sense of collegiality and shared purpose, which allowed us to network and share best practices in a truly collaborative fashion,” said Donald Ford, MD, Vice President of Medical Operations, Hillcrest Hospital, Cleveland Clinic. “As great as the Summit was, the assembled group was an already converted choir, and we need to continue to drive the value-based message to the rest of the medical community.”

The conference was part of a larger Choosing Wisely learning network open to organizations that are actively engaged in promoting the campaign. With support from the Robert Wood Johnson Foundation, the ABIM Foundation established this network of grantees and engaged organizations to share best practices and barriers to implementing Choosing Wisely. The network includes:

• six webinars per year;
• affinity groups centered on engaging specific audiences such as medical educators;
• a virtual space for shared resources; and,
• resource e-mails of recent peer-reviewed journal and popular media articles.

Immediately following the Summit, several of the grantees and members of other organizations convened at Consumer Reports’ Health Conference to discuss the challenges and opportunities around spreading word of the campaign to consumers and patients.

“[The conference] really was a fantastic opportunity to bring together many of our partners, in one place, to share the great work they’ve been doing and to brainstorm about ways to increase our impact even further in the future,” said Dominic Lorusso, Director of Health Partnerships at Consumer Reports.

Important themes discussed at the conference included:

• how to reach the most vulnerable populations and diverse communities;
• how to help patients engage in meaningful conversations with their doctors;
• how to get the Choosing Wisely message into consumers’ hands at the point of care or decision-making; and,
• the best ways to get providers and employees involved.

The focus on patient involvement at Consumer Reports’ Health Conference reiterated the importance of that group to the success of Choosing Wisely. Future plans to disseminate materials to consumers that were discussed among the attendees included:

• digital circulation of materials;
• modifying materials to meet the needs of local and regional campaigns; and,
• defining techniques for reaching specific populations of consumers.

Visit www.consumerhealthchoices.org for more information on consumer outreach efforts or to access patient-friendly Choosing Wisely materials.