HealthcarePapers 18(1) July 2019 : 9-17.doi:10.12927/hcpap.2019.25874
Invited Essay

Reflecting on Choosing Wisely Canada at Five Years: Accomplishments, Challenges and Opportunities for Reducing Overuse and Improving Quality

Karen Born, Tai Huynh and Wendy Levinson


Overuse is a significant and long-standing issue within Canadian healthcare. Previous efforts to curb overuse have relied predominantly on top-down mechanisms to shape clinician behaviour. In 2014, the Choosing Wisely Canada campaign was launched, with a refreshing, grassroots approach premised on clinicians taking leadership on overuse. Five years later, and by many accounts, Choosing Wisely Canada has fulfilled that original mission, with significant penetration among clinicians. However, the overuse problem still persists and continues to be a challenge for clinicians, administrators, decision makers and patients. Although it is necessary for the clinician community to take leadership on overuse, this alone is not a sufficient condition for change. Many factors contributing to overuse are beyond what most individual clinicians can affect. These are system-level factors, including poorly designed information systems that drive overuse, lack of clinician feedback, outdated organizational processes, misaligned incentives and insufficient training within medical education and institutions on addressing overuse. This article proposes that it is time for a concerted approach to tackling overuse, one that is built on the foundation of strong clinician leadership, in combination with systemic actions to make it easier to do the right things at the front lines of care.  



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