PWYLLGOR STRATEGAETH A CHYNLLUNIO STRATEGY AND PLANNING COMMITTEE DYDDIAD Y CYFARFOD: DATE OF MEETING: 26 January 2014 EITEM AR YR AGENDA: TITLE OF REPORT: ARWEINYDD CYFARWYDDWR: EXECUTIVE LEAD: SWYDDOG ADRODD: REPORTING OFFICER: Choosing Wisely (and link to Prudent Healthcare) AGENDA ITEM - 9 Teresa Owen, Director of Public Health Teresa Owen, Director of Public Health Pwrpas yr Adroddiad (dilewch fel yn addas) Purpose of the Report (delete as appropriate) Ar Gyfer Penderfyniad Ar Gyfer Trafodaeth For Decision For Discussion Er Gwybodaeth For Information ADRODDIAD SCAA SBAR REPORT Sefyllfa / Situation The Welsh Government have recently contacted University Health Boards to encourage Board discussion and focus on the Choosing Wisely campaign and approach. This paper provides some background information on the Campaign and its links to Prudent Healthcare. Cefndir / Background What is the issue? The NHS in Wales, like other healthcare systems around the world, is facing the twin challenges of rising costs and increasing demand, while continuing to improve the quality of care. Optimising value and eliminating waste in medical care is therefore a worldwide concern. Unnecessary tests, treatments and procedures do not add value to care. In fact, they take away from care by potentially exposing patients to harm, leading to more testing to investigate false positives and contributing to stress for patients. And of course unnecessary tests, treatments and procedures put increased strain on the resources of our health care system. Many experts agree that the current way health care is delivered contains too much waste. In the USA, some experts have stated that as much as 30 percent of care delivered is duplicative or unnecessary and may not improve people s health (American Bureau of Internal Medicine - ABIM Foundation). For healthcare professionals and patients the most critical issue is ensuring that patients get the care they need and prefer and not to receive care that is unnecessary or even harmful. What is Choosing Wisely? Page 1 of 8
Choosing Wisely is a campaign that has garnered attention worldwide as a potentially promising approach to the vexing problem of reducing unnecessary or potentially harmful services. Choosing Wisely was launched in April 2012 by the ABIM Foundation in the United States of America to encourage physicians and patients to talk about medical tests and procedures that may be unnecessary, and in some instances, can cause harm. (http://www.choosingwisely.org/). How Does Choosing Wisely Operate? One of the key elements of Choosing Wisely in the US is that it is a grassroots, physician led campaign, with medical specialty societies creating list of tests, treatments and procedures in their discipline for which there is strong scientific evidence of overuse. Choosing Wisely depends on changing physician attitudes and practices as well as patients/public knowledge and attitudes. The central goal of a Choosing Wisely campaign is to change the culture of medical care that has historically supported overuse of unnecessary tests, treatments and procedures. A change from more is better to more is NOT always better in physician attitudes and behaviours seems critical. Principles of the campaign Five principles are the basis for a Choosing Wisely campaign in any country, though the method to achieve it is individualized to the circumstances of each country. The 5 principles are: Physician led Patient-centred communication Evidence-based Multi-professional Transparency Which other countries are currently involved in Choosing Wisely based initiatives? Choosing Wisely has been most fully developed in the United States where over 60 medical societies have created lists of five overused tests, treatments and procedures. Modelled on the United States initiative, Choosing Wisely Canada was launched in April 2014. The campaign has created patient-friendly materials to help patients learn about the tests, treatments or procedures in question, when they are necessary and when they are not, and what patients can do to improve their health. (Two examples of the documentation are attached in Appendix A). Choosing Wisely Canada is working with various stakeholder groups to disseminate the patient materials widely. Choosing Wisely Canada leads the international effort. Italy adopted the principles of Choosing Wisely, incorporating them into a campaign called Slow Medicine (modified from the Slow Food movement), and the Netherlands very recently launched a programme called Wide Choices. In both Italy and the Netherlands the Choosing Wisely programme is part of a larger campaign directed at reducing low-value care of which the creation of lists by physician specialists is only one component. Page 2 of 8
Choosing Wisely efforts are also present in the following countries: Australia: Choosing Wisely Australia Japan: Choosing Wisely Japan Switzerland: Smarter Medicine Wales: Prudent Healthcare PRUDENT HEALTHCARE: The prudent healthcare concept has been developed by the Bevan Commission which defines it as healthcare which is conceived, managed and delivered in a cautious and wise way characterized by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients. Put simply it is about doing the right thing, with involvement of the patient and or public. Prudent healthcare offers an opportunity to drive the use of the evidence base and efficient use of resource whilst maximizing clinical benefit. It offers a further opportunity to fundamentally embed public and patent involvement in decision making and the care that is to be provided. In January 2014, the Health Minister set out his intention to introduce prudent healthcare as a fundamental driving principle to care in Wales in his speech to the NHS Confederation. He has set out a challenge to the NHS to adopt the approach and use it to enable better care, better outcomes and better value from our systems. This was supported by the launch of the Making Prudent Healthcare Happen website and a new online resource : www.prudenthealthcare.org.uk The five principles which underpin the approach are currently outlined as: Do no harm Carry out the Minimum Appropriate Intervention Organise the workforce around the Only do what you can do principle Promote equity Remodel the relationship between user and provider on the basis of co-production. An article by the Bevan Commission entitled International Examples of prudent approaches to Healthcare has examined how a range of healthcare organisations around the world are applying the principles: www.prudenthealthcare.org.uk/international Assesiad / Assessment General acceptance of the Choosing Wisely campaign and also the prudent healthcare approach to date by clinicians and the public is encouraging and probably reflects the public s enduring trust in physicians as healers and credible leaders of health care reform. While the Choosing Wisely recommendations are not completely new, it is clear that the UHB can learn from the approach (and other similar efforts from around the world) as part of its efforts to demonstrate a prudent approach to healthcare delivery. The UHB can also gain confidence from the fact that other organisations and health systems have succeeded with this approach. This can underpin the prudent approach which is integral Page 3 of 8
to the UHB s IMTP (which is currently work in progress). Argymhelliad / Recommendation The Committee members are asked to consider the approaches outlined within the report, and support the continued focus on prudent healthcare across the UHB. Amcanion: (rhaid cwblhau) Objectives: (must be completed) Safon(au) Gofal Iechyd: Standard 2: Equality, diversity and human rights Healthcare Standard(s): Standard 3: Health promotion, protection and improvement Standard 5: Citizen engagement and feedback Standard 6: Participating in quality improvement activities Standard 7: Safe and clinically effective care Standard 9: Patient information and consent Amcanion Strategol y BI: HB Strategic Objectives: The report fits with the 5 elements of the UHB Mission Statement: We will provider care closer to home We will focus on Quality, safety and improving outcomes We will ensure we have a flexible, skilled and motivated workforce We will promote health and wellbeing and invest in prevention We will eliminate waste, duplication and ensure value for money. Gwybodaeth Ychwanegol: Further Information: Ar sail tystiolaeth: Evidence Base: There have been a number of academic papers outlining the prudent healthcare approach, and the subject has been studied by the independent think-tank established to advise Welsh Government, the Bevan Commission. There is also plenty of evidence that certain procedures do not deliver any benefits to patients and are inherently wasteful. For example, there are 867 procedures that NICE say should no longer be performed. We know from quality improvement work in Wales, such as the 1000 Lives work, Transforming Care, and other initiatives that improving patient outcomes and experience can also lead to reducing costs. There are several examples where quality improvements have identified and removed wastage in the system, including dangerous delays, unnecessary repetition of Page 4 of 8
work, and clinical practice that delivers poor outcomes. Rhestr Termau: Glossary of Terms: Partïon / Pwyllgorau â ymgynhorwyd ymlaen llaw y Pwyllgor Strategaeth a Chynllunio: Parties / Committees consulted prior to Strategy and Planning Committee: Effaith: (rhaid cwblhau) Impact: (must be completed) Ariannol / Gwerth am Arian: Financial / VFM: ABIM Foundation: American Bureau of Internal Medicine Foundation IMTP: Integrated Medium Term Plan UHB: University Health Board None. Part of the essence of Prudent healthcare is that we should focus on the minimum effective intervention, agreed between clinical and patient, and avoiding for example preference misdiagnosis (providing the care we think patients want, rather than focus on what they might choose when well informed). The focus here is to do less rather than to do more, which carries an inherent positive financial impact if we can tangibly and systematically implement this. Risg / Cyfreithiol: Risk / Legal: Answadd / Gofal Claf: Quality / Patient Care: Gweithlu: Workforce: The Prudent healthcare approach has the potential to contribute to mitigation of several of our corporate risks, such as access to services and meeting the requirements of the equality legislation. Prudent healthcare has quality and safety, based on evidence of effectiveness, at its heart. It also places a coproductive approach between clinician and patient right at the centre. Our UHB Prudent healthcare approach will therefore provide added benefit to the quality and safety of our care, and to the experience of our patients. Prudent healthcare will help create a service that is sustainable in the long-term, by focussing on delivering high quality care. Most people who work in NHS Wales have trained in order to help and care for people, but there are other demands on their time. Reducing the workload by removing unnecessary tasks and procedures would help staff by freeing up time so they can concentrate on helping patients. Adopting new procedures and treatments based on the evidence that they result in better outcomes for patients Page 5 of 8
Cydraddoldeb: Equality: could mean some staff could need retraining or are could be asked to work in different teams. This might affect working hours or shift patterns, but this would be discussed with staff if they were being introduced. Equality of health care treatment forms part of the Prudent healthcare approach. As the UHB progresses with the prudent healthcare approach it should have a positive impact on equality and diversity within our population. Page 6 of 8
Page 7 of 8 APPENDIX A
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