Inspired in Washington
I was honored to keynote the recent Choosing Wisely Summit held by the Washington State Choosing Wisely Task Force. Comprised of the Washington Health Alliance, Washington State Medical Society and the Washington Hospital Association, the Task Force has been a leader in developing community collaborations focused on the measurement and implementation of the campaign.
I’ve developed a bit of a routine with my Choosing Wisely® talks that I think helps set the tone for the room and underscores the importance of our work to reduce unnecessary or overused tests and treatments. Given the makeup of the audience, I was particularly interested in seeing how this technique would play out.
I first asked members of the Choosing Wisely Task Force to stand, and about 20 people stood. I then asked everyone who was involved in some type of Choosing Wisely implementation to stand. In just a few seconds, the entire room was on its feet. From where I stood it was truly an inspiring sight – collaboration among a consumer/patient multi-stakeholder group, a medical society, a hospital association and lots of medical groups throughout the state of Washington. If only this collaboration existed throughout the nation – think about how different our health system would be.
I was even more inspired as I learned about how the Task Force goes about its work. They’ve developed an infrastructure that fosters collaboration and sharing across institutions by using a framework based on intrinsic motivation of improving care. In an environment often fraught with organizations working as siloed competitors, it has been able to break down barriers and get institutions to work not against each other, but against a shared foe of overuse and waste.
This work has already resulted in several positive outcomes. In 2014, Washington was the first to produce a state-level report to measure appropriate use of select Choosing Wisely recommendations. To help both large and small physician practices in their efforts to implement the campaign across the state, the Task Force created a Choosing Wisely Action Manual. In the spirit of collaboration and sharing, the Action Manual is freely available for any organization wishing to join in the effort to improve care.
Additionally, the Task Force created Claims-Based Technical Specifications for 11 Choosing Wisely recommendations to inform community discussion and measure refinement.
The outcomes of this work are also evidenced by projects at institutions across the state, including Virginia Mason Hospital and Medical Center, Swedish Medical Center, Fred Hutchinson Cancer Research Center and Group Health Cooperative.
For example, at Virginia Mason, primary care department claims data showed that antibiotics were being inappropriately prescribed for 82 percent of acute bronchitis cases. Underscoring the importance of teams working together to reduce overuse, Virginia Mason staff developed a phone protocol that connected patients requesting appointments for acute respiratory symptoms to nurses who helped manage symptoms without an office visit. Virginia Mason reported that its interventions helped reduce prescriptions for antibiotics commonly prescribed for upper respiratory conditions by more than half – from 41.8 percent in 2011 to 18.6 percent in 2014.
Swedish Medical Center embraced Choosing Wisely recommendations from the Society of Hospital Medicine and the Critical Care Societies Collaborative warning against too-frequent ordering of lab tests. A review of ordering patterns found five or six out of a staff of 60 physicians were responsible for 50 percent of daily labs. Project leaders created a simple email based intervention that included data on physician ordering patterns, coupled with educational messages explaining why daily labs were wasteful. After a year, 20 percent fewer labs were ordered, equating to 14,000 less lab orders than the previous year.
While the Summit has ended, the inspiration it provided endures. The participants and good work of the Choosing Wisely Task Force truly show not only professionalism in action and but also how community collaborations can lead to measurable health care improvement.
Daniel B. Wolfson
EVP and COO, ABIM Foundation