‘The Manitoba Advantage’ and Choosing Wisely

 

Name of Project Leads: Dr. Eric Bohm & Mr. Jim Slater

Other Team Members: Dr. Abdi Sokoro, Dr. Laurel Thorlacius, Tracey Pearson, Lisa Kendrick, Dorothy Kennedy, Maureen Fenwick (Diagnostic Services Manitoba Biochemistry team that led Vitamin D testing work)

 

The Choosing Wisely Manitoba story started in the spring of 2013. Jim Slater, CEO of Diagnostic Services Manitoba and Dr. Eric Bohm, an orthopedic surgeon at the University of Manitoba’s Center for Healthcare Innovation, were interested in implementing some of the recommendations from the US Choosing Wisely campaign.  Rather than see this as a project, Slater and Bohm described this work to their colleagues as “a new way of working”.

Slater and Bohm worked to educate and raise awareness about Choosing Wisely with physicians across the province and worked with the University of Manitoba Faculty of Medicine, the College of Physicians & Surgeons of Manitoba, Doctors Manitoba as well as the Manitoba College of Family Physicians to engage and educate physicians from across the province about Choosing Wisely.

To start implementation efforts, two recommendations were selected and physician leads were identified. Importantly, recommendations that could be measured and evaluated province-wide were selected. This was done with the goal of demonstrating that implementing Choosing Wisely recommendations can work, and having the data to back up these claims. For Vitamin D testing, a senior endocrinologist led the efforts and helped to gain credibility amongst their physician peers. For preoperative diagnostic testing an anesthesiologist led the work.

Rather than seeing these two implementation efforts as pilot projects, they have been described as ‘proof of concept’. And the concept has worked in Manitoba with major measurable decreases in Vitamin D testing as well as preoperative diagnostic testing.

Sharing the impressive results of these projects has helped to engage physicians in the Choosing Wisely initiative.  Sharing results has meant providing tangible examples of how capacity in the health care system can be freed up when unnecessary care and waste is reduced. For example, demonstrating how resources, dollars and time spent on unnecessary Vitamin D testing can be reinvested in new areas of diagnostic testing that provide higher value to patients and provider. Significant reductions in unnecessary pre-operative testing, one of the Choosing Wisely Manitoba priorities, will improve patient flow, decrease delays, allow testing resources to be used in more important areas and remove patient stress associated with unnecessary testing.

The proof of concept work is not limited to physicians. Choosing Wisely Manitoba is looking towards working with pharmacists on medication appropriateness and reconciliation efforts, as well as with nurses on antibiotic stewardship.

Clinicians and patients in Manitoba are all on board with freeing up capacity to provide care that is needed by reducing or eliminating unnecessary tests, treatments and interventions. And as Slater and Bohm say “the Manitoba advantage is that we are a closely knit clinician community so we can connect directly with people to show them the value of this work.”