Choosing Wisely Canada Hospital

Choosing Wisely Canada’s Hospital Designation Program is intended for all Canadian acute care hospitals. If able to meet the application requirements, non-acute care hospitals are welcome to participate in the program.

Exclusion criteria:

• Long-Term Care
• Primary Care
• Ambulatory Care only hospitals

Choosing Wisely Canada encourages hospitals of all sizes to participate. While smaller hospitals may have lower patient volumes, which can make it harder to detect changes in outcomes, extending the duration of the intervention can help increase sample size. As a result, it may take smaller hospitals longer to demonstrate measurable changes.

For the purposes of designation, Choosing Wisely Canada defines ‘Health Systems’ as more than one hospital working together under a shared or collaborative leadership structure, where there are opportunities for collective efforts to enhance health services. For applications made as a hospital system:

• Only facilities that meet the individual facility requirements will receive designation (e.g. LTC facilities are excluded from Hospital Designation). 
• A hospital system application requires all sites designated within the system to be participants in the same Choosing Wisely Canada improvement activities (self-directed QI projects, Using Labs Wisely and/or Using Blood Wisely as applicable). 
• Aggregated site data may be submitted if it is inclusive of all participating sites. 
• Data from all sites must demonstrate sustainability to maintain designation.  
• For Leadership status, health systems must demonstrate mentorship outside of their Health System.

The application can be submitted in French or English as the review panel includes bilingual members. Questions about applications and discussions with the Choosing Wisely Canada team, however, will be in English. Please find the French language Hospital Designation Guide and Application here.

Yes, climate-conscious recommendations are eligible to be considered as a self-directed QI project.

The initial implementation of the self-directed QI project needs to have taken place within the last four years. The most recent datapoint reported in the SPC or run chart should be within six months of application submission.

• The project is clearly aligned with a CWC recommendation, climate conscious recommendation or toolkit (embed links for each)
• You have or can access pre-intervention baseline data and post-intervention data to measure change over time
  You have established a SMART goal/aim statement
• The scope of the project should apply to multiple departments within the hospital (i.e. should not solely apply to one internal medicine ward)
• The project should engage cross-discipline stakeholders (e.g. Physicians, nurses, hospital administrators).
• You are able to describe your interventions/change ideas and label them on your SPC/Run chart
• You have developed a clear sustainability plan

All data are required to be displayed as an SPC or run chart (data over time). The submission should include 10-12 datapoints pre-intervention and 10-12 datapoints post-intervention (total of 20-24 datapoints). The data can be displayed weekly, bi-weekly, monthly, quarterly, or annually. Interventions should be annotated on the time series chart.

A successful intervention or intervention bundle would be demonstrated by a clinically significant reduction or a statistically significant reduction by SPC rules. For more information on SPC charts please visit:

Ontario Health Measurement for Quality Improvement 2024

The former Level 1, 2 & 3 program ended in 2021. Therefore, sites can no longer apply their Level 1, 2 or 3 credits toward the current program. 

Step 1 – Review the Hospital Designation Program Guide to ensure you meet the application requirements for the designation you’re interested in.

Step 2 – To ensure that your self-directed QI project is eligible, please consider consulting with Choosing Wisely Canada prior to your submission (info@choosingwiselycanada.ca).

Step 3 – Download the application form for the designation stream of interest (QI Application or Leadership Application).

Step 4 – Complete application and create a single file (PDF or Word format) containing all supporting data (SPC charts) and supporting documents in a comprehensive format for review.

Step 5 – Submit application and supporting data document to info@choosingwiselycanada.org

It takes approximately 8-10 weeks from submission to granting designation status. Sites will be notified if the panel has any questions about the application.

• Provide watermark signatures and digital packages
• Connect with hospital communications, if requested
• Post on Choosing Wisely Canada’s website with spotlight and profile opportunities

To maintain designation status, hospitals will be required to complete a sustainability update report one year after designation and every two years thereafter. Depending on the pathway the hospital took to earn credits toward designation:

• Remain in good standing with Using Labs Wisely (2 credits)
• Remain in good standing with Using Blood Wisely (2 credits)
• Submit updated data for self-directed projects (1 credit each)
• Leadership Status Only: Demonstrate continued organization-wide commitment to Choosing Wisely Canada (e.g., strategic plan, established structures within the organization, Choosing Wisely metrics on hospital scorecard, quality improvement plans and projects related to recommendations)

You may consider adding links to Choosing Wisely Canada toolkits and recommendations to your internal website or create posters with QR codes linking to Choosing Wisely Canada resources to put up on boards throughout the hospital.

If a site cannot continue the improvement activities associated with its designation, it should discuss alternative options with a Hospital Designation Program team member. If they determine that the site can no longer sustain the work, the designation will lapse. This will be noted on the web-site with the active designation period (e.g., 2022–2025), and the organization will be informed.

Sites are encouraged to contact info@choosingwiselycanada.org with any application specific questions or to talk through prospective