Daniel Wolfson Discusses Hopes for Choosing Wisely Initiative

A major goal of the Choosing Wisely program is to educate and empower both the clinician and patient communities, eventually reducing the overuse of resources, according to Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation.

Transcript (slightly modified)

What are your hopes for Choosing Wisely and how would you like it to evolve in the future?

Well, I think that the future of Choosing Wisely is on several fronts. We’re seeing non-physician organizations enter the Choosing Wisely campaign. Nurses are a part of the campaign now, PTs are a part of the campaign, dentistry, and pharmaceutical associations coming in next year. So we’re more team-based, which is good to see, that it’s just not physician-based: it’s clinician-based, and clinician-led.

And we’re seeing organizations take up the recommendations and begin to implement them using various quality improvement techniques, some that really focus on implementation of new patterns, but also organizations are focused on deimplementation, and what does that mean. But it is not going to just happen by itself.

Many articles have been written, not many, but several articles have written that Choosing Wisely hasn’t been effective in changing behavior. Well, it’s usually when there’s nothing being done, it needs an intervention. Behavior doesn’t just change by promulgating recommendations or promulgating clinical guidelines. We know that from the last 30 years in healthcare, that you need to have a strategy that changes behavior, that reinforces, that changes habits that have been ingrained.

And organizations that have done that have found incredible reductions in healthcare. LA County has reduced preoperative surgery by almost 50%. Remarkable, but it didn’t happen just by itself. It happened because there was education, there was peer comparisons, and people began to change behaviors.

You know, the Carrie Colla article just recently put out by AJMC, was really I think right on target for what the campaign was trying to do from the very beginning, and that was to have a conversation, have a dialogue, and legitimize the notion that physicians could take leadership along with patients in trying to reduce overuse. And that article by Carrie Colla, over 90% of the physicians polled in this large medical group in Boston said that the recommendations were legitimate. They were right on target, they agreed with them. And 75% felt that it empowered them to do the changes that they thought were necessary, and to me that’s right on target.

Another article talked about Choosing Wisely, among other efforts, has made overuse, the reduction of overuse, a professional responsibility. Again, that was right on target what we were aiming to do. We wanted to develop a conversation, we wanted to change the mindset, and we wanted to empower and develop ownership by the clinical community and the patient community around this problem. And that’s what we think we’ve done with Choosing Wisely.