1. Choosing Wisely Supported through System Level Clinical Quality Governance
Dr Sharon Kletchko MD FRCPC FRACP
Quality Risk Clinical Governance Director
Lakes DHB

2. Clinical Quality Governance (CQG)Principles
Managed through networking & feedback at all levels
Clearly defined roles, responsibilities & accountabilities
Ensures clarity & consistency of standards
Uses evidence-based methodologies
Promotes a culture of openness & transparency
Enables good performance management of individuals & teams
Ensures a culture of continuous improvement – energetic & enthusiastic willingness to work across the system
Supports autonomy of department level decision-making
Supports ‘whole Organisation) ‘quality’, ‘innovation’ & ‘change’
Enables the focus on patient / whanau ‘connectedness’ from bedside to board-room

4. A Networked/Linked approach
Patients
Whanau
Subcommittees
Choosing Wisely, IPC, Resuscitation, PAC, Child & Youth, HiAG, Medical Education, System-Level CQI, M&M, audit
Professional
Forums
Clinical Teams

5. LDHB CQG & Choosing Wisely
Importance of broad governance and extensive follow-up essential to success
CQG provides an ‘Organisational decision-making structure’ using ‘iterative feed-back loops’ and ‘team of teams’ approaches
The CQGE provides:
the over-arching leadership to drive the process of dissemination, cross-fertilisation, and system response
Resources to disseminate and to implement
Background to ‘Choosing Wisely’ and FRACP ‘EVOLVE’ programmes
The Choosing Wisely campaign aims to promote conversations between clinicians and patients by helping patients choose care that is:
Supported by evidence
Not duplicative of other tests or procedures already received
Free from harm
Truly necessary
In response to this challenge, national organisations representing medical specialists asked their providers to “choose wisely” by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed.
The resulting lists of “Things Providers and Patients Should Question” are intended to spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.
EVOLVE [Evaluating Evidence, Enhancing Efficiencies] is a physician-led initiative to ensure the highest quality patient care through the identification and reduction of low-value practices and interventions
Low-value care is use of an intervention where evidence suggests:
it confers no or very little benefit on patients, or,
risk of harm exceeds likely benefit, or,
the added costs of the intervention do not provide proportional added benefits.